Cup Feeding Strikes Again! - page 2

So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and vaginal delivery. He had some low blood sugars (which we call... Read More

  1. by   TiffyRN
    Quote from dawngloves
    :uhoh21: I just got a lot of journal articles. Honest!

    Yea, you're right. Several years ago when I was going through our internship program it was true, but honestly I haven't really checked since then.
  2. by   BittyBabyGrower
    We use colostrum for priming feeds. We make sure the mom puts the first few days in a separate container so we know which to use first. It helps to get flora growing and mec moving. If we have a kid with a really high bili, we will alternate colostrum with formula (bili binds to formulas and colostrum makes them poop!).

    In NICU, we get way hung up on kcal's per kg and ml's per kg and what is the glucose load we are giving.
  3. by   PremieOne
    I am an advocate for breast feeding but this idea of nipple confusion is all wrong. I have been a nurse for 40 years and have never seen any infant with nipple confusion. There were many moms who were being pushed into breastfeeding either by the staff or family when the mom did not want to breast feed.
    I think it is terribly wrong to force an infant to cup feed or syringe feed just because the mom or family member feels the infant will develop nipple confusion. I have had many heated discussions with our lactation specialist on this issue. Forcing an infant to feed this way is not helping the infant learn how to suck properly. We have had OT specialist trained in feeding disorders agree that this is an improper way of feeding a newborn.
    As several other members have stated that if the infant is allowed to be hydrated with use of bottle feeding, the infant will gladly return to breast feeding because she/he feels better. We have moms continue to breast feed and then give supplement and have moms pump q3h when not able to be with infant. Moms are much happier when she takes infant home healthy.
    We are now trying to get banned any syringe or cup feeding in the NICU. We all feel it is a dangerous idea and puts extra stress on an already compromised infant.
  4. by   nell
    Quote from newbiern2006
    quite frankly, i don't understand the whole blood sugar issue in the first place - i've known some homebirth midwives for years, and none of them ever test a newborn's blood sugar, and none of those babies have suffered any harm (actually, their record as far as infant and maternal mortality and morbidity is better than hospitals', even in "high risk" populations). their moms just keep on breastfeeding them until their milk comes in, and that's that. our grandmothers did it that way, and none of our parents died of "low blood sugar." why do doctors think they need to mess with nature?
    so midwives don't test the infants of diabetic moms? or lgas, sgas or preemies? and how "high risk" are you talking?

    how do you know those babies didn't suffer any harm? where harm from low blood sugar shows up is in learning disabilities and maybe autism.

    as far as "our grandmothers" doing it that way - - - people used to live in extended families and/or groups. there was usually a lactating woman around to feed the screaming/starving infant when the mother's milk hadn't come in yet and the colostrum wasn't enough or the mom just couldn't produce for any reason. the rich had wetnurses. today we have bottles.

    thank goodness our hospital doesn't allow any of those nutty "alternative" feeding practices, although the lactation consultants still try to pull a fast one now and then. one of our long term preemies visited a while ago- the lc got her to syringe feed the kid after discharge and a year later she was still being fed by syringe!

    then there's the practice of giving iv fluids instead of that nasty unnatural bottle when the mom wants to breastfeed exclusively and the kid needs hydration. an iv is soooo much more natural.

    in 20 years of neonatal care, the "nipple confusion" i've seen has been the result of flat or inverted nipples that the kid just can't get a latch onto. it's not confusion, it's physiology.

    nell
  5. by   33-weeker
    I have seen nipple confusion. I can always tell the BF babies who got bottles the night before - they go back to mom, latch, but then spit the nipple out repeatedly instead of sucking and drawing the nipple in.

    Most can be suck re-trained with a gloved finger farily easily. A few can't. The problem is, you don't know which baby it will be who will persist in refusing the breast.

    I'm not, however, a 'breastfeeding natzi', but I will bend over backwards to respect a mom's wishes for no bottles if at all possible.
  6. by   Gompers
    The only thing that really concerns me about exclusive breastfeeding from the start is hydration. Yes, colostrum is very high in nutrition, I completely agree with that - but it's sometimes not enough fluid volume for a baby. I can't tell you how many babies we've admitted to the NICU from the ER or peds clinic who have bilirubin levels over 25 because they've been exclusively nursing since birth and are incredibly dehydrated. Their blood sugars are fine, that's never the issue with them. These aren't babies with blood type incompatibilities, either. I wish there was some natural way to provide fluid to these babies without disturbing breastfeeding.

    Maybe if we still lived outside like cavemen then our babies wouldn't get so jaundiced in the first few days because they'd be getting plenty of sunlight. Seriously, it's an evolutionary theory to ponder...
  7. by   33-weeker
    About hydration -
    I had twins (36 weeks, 6 & 7 lbs). One nursed well, the other had a weird suck - not weak, just different - and had trouble transferring enough milk from the breast. He developed a late-onset ('breastmilk') jaundice that never got really bad, but lingered for a couple of weeks. I switched him to EBM by bottle and the jaundice was gone in less than 48 hours. It was not the breastmilk that was the problem, but the fact that he wasn't able to transfer enough of it when he sucked.

    My daughter had a similar suck (term, 9 lbs - my first baby). She had 15.6 T Bili on day 3. but with home photo, it went away and never got higher. I gave a couple of 10-15 cc sterile H20 supps., but exclusively breastfed her. In retrospect, her jaundice might have gone away quicker had I pumped and given EBM by bottle some.

    I made tons of colostrum and mature milk, but if the baby can't transfer enough of it, what good is it. I think the problem more often lies in the ability of the baby to suck properly and transfer enough milk, not in the mom's ability to produce.

    Something to think about.
  8. by   Gompers
    These particular babies were dehydrated because the mother wasn't producing much milk - when they'd pump, they'd get drops instead of ounces. Maybe it's because the babies weren't sucking well, who knows. Either way, hydration was their issue, not the breastmilk itself.
  9. by   33-weeker
    I've seen that, too.

    I guess the point I was making was that many moms have sore nipples and dehydrating babies. Perhaps it is the baby's suck and not always the mom's supply.

    I'd been a nursery nurse for years and adept at latching newborns when mine came along. Even with oral motor therapy I was taught to do, my kids with suck issues still hurt me and had feeding problems. The twin I spoke of never was able to get back on the breast. I pumped 25-30 ounces /day (while also nursing his twin) for him for 5 months just so he could get at least some breastmilk.

    Anyhow... It's frustrating to want to breastfeed and not be able to fix the baby's suck. Like you, I too wish there was a way to supplement without hindering the process.

    I have had success with syringe feeding (short-term, of course). I am always surprised how much they can take so quickly by just dripping it in a few drops at a time. The baby must be cooperating and swallowing it down. But those dehydrating BF kids usually are eager. LOL
  10. by   LYRICS84
    I would like to share my thoughts on this subject. First, nipple preference DOES exsist. I can tell by observing the infant at the breast if he/she has had a bottle. When an infant feeds from a bottle the baby doesn't have to "suck",the milk drips right in the baby's mouth. Babies easily get overfed if the nurse is not careful to limit the amount consumed. When offered the breast after the bottle the baby will latch and then wait for the milk to "drip in". When this doesn't occur, the baby will usually cry and pull away from the breast. Not, only that but formula is not completely digested by the infant, so all the undigested material sits in the infant's stomach and makes him feel full so he doesn't get the hunger signal to want to breastfeed every 2-3 hours as needed for mom to establish and maintain an adequate milk supply. Sounds like a great start to a solid breastfeeding relationship there Yes, there are exceptions to every rule, some babies have done well with both feeding methods. I have literally worked with thousands of breastfeeding couplets in my career and have found this in some cases, but certainly not the norm.

    Also, the comment was brought up on the hydration issue and that colostrum sometimes isn't enough to sustain a infant to avoid dehydration. If a infant has been exclusively breastfed and is dehydrated then the infant WAS BREASTFEEDING POORLY. Just because an infant is at the breast sucking away doesn't mean he is obtaining adequate milk transfer.

    Now, about cup feeding. If your baby aspirates while cup feeding, then you are pouring the milk into the baby's mouth, which should never be done. There is a technique to correctly cup feed a baby, I teach parents and have NEVER had a baby aspirate. Learn the correct technique and baby can easily consume 30 cc. By the way, feeding 90 cc at a time is considered overfeeding where I'm from. A newborn's stomach capacity is about the size of a marble at birth, a typical newborn breastfed baby obtains a couple of teaspoons of colostrum during a good feed.

    TiffyRN wrote:

    "What is the caloric content of colostrum? Because if it's too far off of 20cal/oz then the NICU's need to modify their feeding policies, many of our micropreemies do not need "high carb" feedings into their delicate undeveloped guts"

    Tiffy, micropreemies especially need breastmilk over formula for their "delicate undeveloped guts". There is numerous research that supports this. I would be happy to share my sources with anyone that is interested.

    Thank you for listening.
  11. by   ElvishDNP
    [quote=LYRICS84;2010814]I
    "What is the caloric content of colostrum? Because if it's too far off of 20cal/oz then the NICU's need to modify their feeding policies, many of our micropreemies do not need "high carb" feedings into their delicate undeveloped guts"

    Tiffy, micropreemies especially need breastmilk over formula for their "delicate undeveloped guts". There is numerous research that supports this. I would be happy to share my sources with anyone that is interested. [quote]


    Also, the colostrum content of a mom breastfeeding (or pumping for) a preemie is way different than that of a mom of a full-termer. So probably that mom's colostrum is just right for her particular baby.
  12. by   LYRICS84
    arwen u, you are exactly right. here are some reasons to provide mom's ebm or donor milk to preemies.

    gastrointestinal benefits
    faster transit time in stomach [font=trebuchet ms, arial, helvetica]reduces intestinal permeability. the gut of the preterm infant appears to be a less effective mucosal barrier than that of term infants. oral feedings that promote the bacterial colonization with beneficial bacteria are essential for normal maturation and the associated immune system. iga, abundant in breastmilk, "paints" the lumen of the gut inhibiting the penetrating of antigens and microorganisms. [font=trebuchet ms, arial, helvetica]less residual milk in the stomach at the time of the next feeding [font=trebuchet ms, arial, helvetica]breastmilk is well tolerated [font=trebuchet ms, arial, helvetica]laxative effect of colostrum and the enzymes in breastmilk that "pre-digest" nutrients are important for the immature digestive systems of preemies [font=trebuchet ms, arial, helvetica]faster progression to full oral feedings [font=trebuchet ms, arial, helvetica]stimulate gastrointestinal growth, motility and maturation [font=trebuchet ms, arial, helvetica]enzymes help immature infants absorb and utilize nutrients more efficiently [font=trebuchet ms, arial, helvetica]improve absorption of nutrients when breastmilk and special formulas are combined [font=trebuchet ms, arial, helvetica]less need for tpn (total parenteral nutrition)

    anti-infective benefits reduced episodes of bacteremia and sepsis [font=trebuchet ms, arial, helvetica]fewer urinary tract infections [font=trebuchet ms, arial, helvetica]reduced incidence of necrotizing enterocolitis. research shows that infants who receive breastmilk have a lower incidence of necrotizing enterocolitis and other infections. [font=trebuchet ms, arial, helvetica]babies born prematurely miss out on the transfer of calcium, iron and immunoglobulins via the placenta that occurs during the third trimester of pregnancy. the only way premature infants can receive the crucial infection fighting immunoglobulins is from breastmilk from lacation education resources
    and from the aap

    the american association of pediatrics (aap) states: 1)
    "human milk is species-specific, and all substitute feeding
    preparations differ markedly from it, making human milk uniquely
    superior for infant feeding", 2) "human milk-fed premature infants
    receive significant benefits with respect to host protection and
    improved developmental outcomes compared with formula-fed premature
    infants", and 3) "hospitals and physicians should recommend human milk
    for premature and other high-risk infants either by direct
    breastfeeding and/or using the mother's own expressed milk."
    http://aappolicy.aappublications.org...iatrics;115/2/
    496


    i apologize for the lengthy reply, but felt all of it was important to post.
  13. by   TiffyRN
    Tiffy, micropreemies especially need breastmilk over formula for their "delicate undeveloped guts". There is numerous research that supports this. I would be happy to share my sources with anyone that is interested.


    Sorry, I screwed up the quote above but it was from Arwen U I think ?



    So, after 4 1/2 yrs in a level III NICU I KNOW micro's need breastmilk over formula, Our unit won't even give formula to a kid under 30 weeks, if mom has none, we will give donor milk, haven't had any parents refuse so far when rationale is given. It hurts me to give initial feedings to any preemie with anything but breastmilk. I love for the babies I'm caring for to get breastmilk. I'm a big fan of breastmilk. Can I make it any clearer?

    What I'm not a fan of is not seeing the forest for the trees. What am I talking about? Claiming that colostrum is so powerful it can sustain a stressed (NOTICE, I am saying stressed, not normal) newborn. It must have something like 100cal/oz!! I don't buy it. And part of my doubt comes from the assumption that our Neo's wouldn't put something that rich full-strength into the guts of our itty-bittys. I want to see the research proving that drips of colostrum will raise the blood sugar of an infant struggling with blood sugar issues (as it is the policy of our general nursery to put the baby to breast if the blood sugar is slightly low, even if obviously the mom's milk is not in).

    2nd issue for me. The case I spoke of originally. This was obviously an infant right on the edge. His sugars were easily controlled with slightly increased intake. 50-60ml's (on day 2 of life) of 20cal/oz formula raised his sugars to the normal range (62-75). But when this child was breastfed (and he appeared to be doing it well for all we could see with a mom who was an experienced breastfeeder) his sugars dropped. When cup fed 20-35ml's after breastfeeding, his sugars were not good enough (ranging 34-49). So, this poor child in my opinion fell victim to the new breastfeeing/cupfeeding policies in our hospital. Because he couldn't keep his sugars up on BF and cupfeeding, he was admitted to the NICU, thereby separating him from his mother (even with open visitation, you know they are together as much as if he had been in a couplet with his mom) and then having his anticipated discharge delayed about 24hrs.

    So what I'm wondering is; which is more harmful to the mother/baby relationship and the breastfeeding relationship? A bottle PC to keep his sugars in the safe range until his mom's milk comes in which holds a disputed possibility of nipple confusion, or an admission to NICU with separation from the mother?

    Once more let's review; I am not against breastfeeding. I did not start this discussion to be a breastfeeding vs. formula feeding discussion. What I am is very much anti-cupfeeding. Case in point was this infant though, something was just a little off (he was a slightly stressed infant, had TTNB for a few hours after meconium stained delivery). He could have been spared an admission to our NICU and separation from his mother if our policies had not mandated cupfeeding for breastfeeding infants; or if gasp his mother had not wanted to BF and wanted bottlefeeding instead.

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