by BabyLady

I my short time in the NICU, I am shocked at how early feeds are started.

Yesterday, I saw a baby die from perforation two days after starting feeds (25 weeker).

A month ago, I saw the same, exact thing, with a 24-weeker.

These kids are on vents, their color is not good.

So why the rush to start the feeds??????

I can't help but wonder if these contributed directly to the deaths. The 24-weeker was one of a set of triplets....and the only one to get the feeds. Other two were doing well.

Re: Early feeds...good idea or recipe for disaster???

I also wanted to add, that the 25-weeker that died...had never passed the merconium.

Bowel sounds were good on that baby and the baby did not have any signs of distention or loops.

Re: Early feeds...good idea or recipe for disaster???

What were they fed? We are starting trophic feeds on stable micros. 1ml q 6, breast milk only.

Re: Early feeds...good idea or recipe for disaster???

I agree with dawngloves.

There is a big difference between trophic feeds of a miniscule amount of breastmilk intended to protect and stimulate the gut and true feedings which may overtax the child's gut and immune system.

What was being fed, and how much?

Re: Early feeds...good idea or recipe for disaster???

Originally Posted by BabyLady

I also wanted to add, that the 25-weeker that died...had never passed the merconium.

Bowel sounds were good on that baby and the baby did not have any signs of distention or loops.

Has an autopsy been done? Might this be a case of an undetected congenital anomoly? This certainly doesn't sound like typical NEC.

I'm so sorry for those who mourn this baby's loss.

Re: Early feeds...good idea or recipe for disaster???

Was going to ask the same question as Jolie and dawngloves about trophic feeds. Our NICU does trophic feeds on the stable micros too and doesn't have a very high NEC/perf incidence.

Still...I am sorry.

Re: Early feeds...good idea or recipe for disaster???

We do trophic feeds as well, unless they're getting Indocin for a PDA.

Was the infant getting Indocin? That could explain the nec.

Re: Early feeds...good idea or recipe for disaster???

It could just be a coincidence too...I don't have any literature to back me up but I feel like I've seen several spontaneous perfs in fresh micros that had either never eaten or weren't eating at the time. At lunch one day we were actually talking about how it's a miracle that they don't perf more often. Their intestines have to be paper thin...

Re: Early feeds...good idea or recipe for disaster???

I don't know anything about babies, but in adult critical care there is a multitude of data to show that early feeding improves outcomes tremendously.

Re: Early feeds...good idea or recipe for disaster???

Originally Posted by ghillbert

I don't know anything about babies, but in adult critical care there is a multitude of data to show that early feeding improves outcomes tremendously.

Fortunately most adults have well developed GI systems despite what caused them to be in the ICU in the first place, infants born at 24 weeks do not have developed systems, in their case feedings become a necessary risk and depending on the baby it may benefit them to wait rather than feed them too fast and cause perforations