Hi everyone, I've been a nurse for a few years now, mostly in adult critical care, and have been working full-time in a level 3 NICU for about 7 months now.
As someone new to the field and still honing assessment skills, one of the things that scares me the most is NEC, and I am curious what some of you think about feeding and feeding intolerances.
The general rule of thumb in my facility is that any residuals that are 20% or greater of the original feed need to be brought to the MD's attention, if a baby is on bolus feeds. If a baby is on a continuous feed and has residuals after a 2-hour-off period that are equal to or greater than one hour of feeding, then alert the MD.
I recently had an infant born as a micro-preemie that is now in the 29-30 week range who was on basically a 5ml breast milk gut-priming q3 feed schedule, and had been having 3 to 5ml residuals consistently throughout the day. On my initial assessment for the shift, I got 7mls of pretty much very partially digested milk. I called the resident, who came with the attending to examine the baby, and the attending essentially asked me to feed the 7ml residual and give the full 5ml of milk. I didn't agree with that, and I argued with her until she agreed to refeed the residual and recheck at next feed.
Basically, I want to get a sense of what others feel as far as feeding intolerance goes. The attending told me that a baby cannot not tolerate feeds (not not, yeah--my words, not hers), when the feeds are only 5mls. But if you're only feeding small amounts, how is it ok to keep shoving residuals back with more and more milk behind them? It just doesn't make sense to me, and I really never want to have a baby NEC on my shift, so I am very very careful with residuals in the tiny ones.
I dunno. Am I overthinking this? What's your facility's handling of feeding intolerance?