So I wanted to get opinions on something that happened while I was at work the other day. I am a former nicu nurse who about a month ago changed to peds cardiac icu. So far I love it, no complaints, I am learning a ton, still getting to take care of lots of babies but a lot has been a big adjustment that I'm still working through. So my situation is the first argument i've gotten in with my preceptor. Got report on a little guy 3 weeks old/3 weeks post open heart surgery. At this point just feeding/growing and weaning off his vapotherm. Night nurse tells us he's been having trouble gaining weight on breast milk fortified to 26cals so they started him on a feeding regimine of 4 hours breastmilk/4hours formula (continuous) and he has started gaining weight. I thought that was a little odd but went with it. Then I went in his room for my first assessment and saw his breastmilk hanging in a kangaroo bag! :smackingf: So I nicely talked to my preceptor about it and about how he was getting no fat/nutrients that way and they were essentially feeding him fortified water, no wonder he wasn't gaining weight
She proceeded to get upset at me that I needed to get out of my "Nicu" mindset and welcome the ways other units do things...which I am totally fine with and understand, but a baby who is being malnourished because of the feeding style i'm not going to just ignore. It is also our hospital, NOT just nicu, but hospital policy that breastmilk be given via syringe if baby is not po feeding, and we have special double syringe tubing that you can use to run two syringes at once if they baby is getting a large volume and you dont want to have to change out the syringe every 2 hours.
Am I wrong for questioning this units practice? Does anyone else use kangaroo bags for breastmilk? Or should I address it with the educator and maybe some more education can be provided to the unit? (Which probably wouldn't be an issue, this unit is HUGE on education)
I also hate to think of the mommies who have nothing else to do for their babies to feel like their milk isn't good enough, especially when its not an issue of tolerance but quality of calories
Corn Oil?? I've never heard of that! Interesting. We use all kinds of stuff (stuff being different formulas) depending on the kid, typically for full term kids starting with enfamil. We do fortify higher in both nicu and pcicu but theres an increased risk for feeding intolerance with the higher calories, especially in kids with hx of hypoxemia for whatever reason...in this case a cardiac defect. And I have definitely never seen someone flush behind the breastmilk with water...if only!
If we run into feeding intolerance we give them gut rest with Pedialyte anywhere from 4-24 hours and then slowly advance at 1/4 strength (with the 1/4 strength formula 100% fortified) and that seems to fix it. We almost never have to decrease the calories for any reason other than our babies getting fat!
This is what I really love about this site. I knew corn oil was on some of our really old instructions in the mixing room area. Then we had an infant going home that still required higher calories. At discharge the infant was getting an additional 3cal/oz of MCT oil. When it was determined the infant needed to continue on this regimen at home and that MCT oil would not be covered by insurance/medicaid (can't remember their coverage), the doctors changed the home order to be so many ML's per oz of corn oil. Very simple and cheap.
I work in a very old referral hospital with limited resources. Most of our kiddos are on govt funded insurance and reimbursement is low. We tend to have to get clever with what we have. MCT oil is too expensive and not billable, so corn oil it is. Works great!
Huh...I learned something new today! I don't think I've ever given a large enough volume of breastmilk to warrant a Kangaroo, but I'll be on the lookout in the future. Thanks everyone!
We also do not put EBM in Kangaroo pumps for the same reason, and we make sure our syringe pumps are horizontal for fat distribution. We actually used to hand them vertically with the tubing pointed upward to push the fats in first but after several studies, decided that it was better for the gradual distribution you get from it being horizontal. The kangaroo bag and tubing collects the fats and there is no way to push the extra fats out to the patient. As far as mixing periodically, not all nurses are as diligent in their feeding, so kudos for at least helping get what you can to the babies! I would agree in getting whatever evidence you can find and talk to your preceptor about it. Good Luck!
We actually used to hand them vertically with the tubing pointed upward to push the fats in first but after several studies, decided that it was better for the gradual distribution you get from it being horizontal.
Were these formal or in-house studies, and, if the former, could you provide references? In my unit there's only the two schools of thought (right-side-up vs. upside-down vertical hanging), and I'd love to offer our CNS some literature on this third option.
umcRN, BSN, RN
867 Posts
Corn Oil?? I've never heard of that! Interesting. We use all kinds of stuff (stuff being different formulas) depending on the kid, typically for full term kids starting with enfamil. We do fortify higher in both nicu and pcicu but theres an increased risk for feeding intolerance with the higher calories, especially in kids with hx of hypoxemia for whatever reason...in this case a cardiac defect. And I have definitely never seen someone flush behind the breastmilk with water...if only!