I know that especially in our culture today breastfeeding is the absolute it thing to do, but sometimes it is not best for the baby, or not done correctly (ex. outside admissions for hyperbili, baby is dehydarated and tada..exclusively breastfeed; we give them the first bottle and they chug it down!). My questions are:
1. What are your thoughts on nipple confusion?
2. Is there a corellation between breast milk and jaundice really?
3. How do you thaw and/do you refridge refreeze milk?
4. using a pacifier?
Of course, in the NICU it's a little different because we have to put the baby's health first, and once it's explained (in an ideal world you could breastfeed your child, but he/she is in the NICU, this is not ideal!) parents are usually better about it. I have noticed that if a baby will BF he will, and if he won't, he needs a little more support, regardless of the bottle feeding.
We thaw out frozen milk, but we put the rest in the fridge.
We do give children pacifiers if they are not eating and need a soothing mechanism.Thoughts? t.
I'd also like to add that when it is doable we absolutely try to help both mom and baby with the process, including setting them up with a lactation consultant. The benefits of breastfeeding cannot be denied, and it's wonderful when it works.
I think it's true that there is usually more to a situation than people realize. At the same time, sometimes I think pple don't give nurses and docs enough credit that they really do want to do the best for the baby. And, while some parents have VALID concerns, and we really do listen when they talk about allergies and other issues, we sometimes still have to choose the best of two evils. Hopefully with all of the information we pick the best course of action.
I think NEC is one of those things that happens due to true, early feeds and immaturity, and now we've noticed a relation b/w other txs and NEC too. Aren't some of our formulas super gentle for babies anyway? Forgive me for my ignorance; i just i noticed that if a baby's tummy starts to look suspicious the docs actually may stop breast milk and start alimentum or something. IVs are still a source of infection too, right?
Of course, to add to the mix, each baby is different, so as we always say, it's never a black and white science sometimes, just shades of gray!
There is nothing more gentle on the tummy than breastmilk. I would be highly suspicious of a dr. who stops a breastmilk feed to begin an artificial milk feed because the child has suspected NEC.
http://vm.cfsan.fda.gov/~dms/inf-ltr3.html This is a good warning from the FDA about why powdered milk-based formulas should not be used in NICUs. Unfortunately, HMF also counts as that as well
edited to fix smiley. I hate that their : ( smiley isn't the sad smiley like the rest of the world, it's an angry looking smiley.)
i think it's more of a case where baby is feeding ok but seems to do worse with the BM feed, and this I have definitely seen, so we try alimentum (ready-made, as our most our formulas except the unusual ones) until the baby is doing better. and, the doctors I work with are part of the most top-notch NICU team in the area, so i trust their judgement, and I would not be "highly suspicious"! If a baby has suspected NEC, we stop the feedings ASAP! I am talking more about a tummy being little full (and come on,they are babies, their tummies may be full due to gas) or irritibility, etc. My point was, I think when you start working regularly on the unit you may notice that not everything is as clear cut as one may expect. Breast Milk is definitely gentle and wonderful for our NICU babies, but like I said each case is different. t.
Wow! I didn't think that breastfeeding would be a hot button issue on a message board for nurses. It's par for the course on parenting boards,just a shock to see it here! :)
Excuse me while I bombard you with links. I believe the information contained within will answer some of your questions.
For clarification,breastmilk does not "cause" jaundice. In fact,as another poster pointed out,breastmilk has a laxative effect and helps to flush out the bilirubin(which is released through the stool). HOWEVER,there is a type of jaundice called late-onset(also called breastmilk jaundice) that seems to somehow be related to something in that particular mother's milk that may increase the reabsorbtion of the bilirubin or perhaps decrease the liver's(baby) processing of the bilirubin. Even in the case of breastmilk jaundice,breastfeeding can continue(please see links above,or do some research of your own).
Since this is the NICU forum,info on bf premature/hospitalized babies:
I don't know what to say to the poster who thinks bf past 12 months is wrong. I wish there is some way I could make you understand that it is not wrong or "bad",but I'm sure there is nothing I *can* say. People only see what is their experience. Maybe you will read the information below and it will give you an idea?
It though is not always as cut and dry though. A parent might choose an IV over formula and you might think it's stupid, but you don't know what their familial allergy history is: maybe she has another child who is severely allergic to milk and/or soy, or she or her husband are. Depending on the age of the child, there's a concern with NEC, which is almost exclusively associated with formula. Enterobacter sakazakii is a known contaminant of powdered formulas and that is a real risk to some kids and if I had to choose between an IV and them potentially getting NEC, I'll choose the IV every day of the week.
That's why we give the parents the choice. What may seem like pointless fussing to you, is the entire world to the parents. This is their child and often times, they think think the sun rises and sets with the child and if they were not in the NICU, they would have choices in caring for their child but when in that environment, it's hard for them to even feel like a parent because the NICU nurses are doing everything for the baby and maybe looking down at you because they don't understand the full situation.
Personally, when my son was in the NICU with RDS and other preemieish issues, I had a nurse say to me "You know, next time you can get proper prenatal care and prevent this from happening" or something to that effect. Well, she can go F herself (I did report her to the nurse manager and had her removed from my child's care). Just because I looked young and sloppy, didn't mean that I was. I owned a home, had a college degree, had excellent prenatal care (which is why he was a 34w and not a 24w or dead) and spent four months on bedrest and medications to prevent his delivery. I just happen to look young and forgive me that after that much time on bedrest and having just given birth, I'm not a fashion plate.
I think NICU nurses need to be more understanding for the caring parents who are in there. Of course there are always some jerks, but there are also parents that are trying to do the best they can in a difficult situation and feeling like the nurse looks down on you wouldn't make it easier.
LilPeanut, We do ask parents about milk allergies, I think that most of the parents who are insistant on "no formula" or "no bottles" are not worried about allergies, or nec. They are convinced that we are going to pour formula down their babies the instant they leave the room. We do everything we can to keep those babies out of the nursery. If at all possible, we put a heplock in the kid, and send it out to room in with mommy, just coming in to the nursery for meds.
If we are lucky, it's a r/o sepsis, and by the time the mom is ready to go home, we can send the baby home, too. Sometimes we send the baby to Pediatrics, so mom can stay until baby can go home.
We don't always have time to cater to the parents, no matter how hard we try. Face it, some parents are jerks, too. I realize this may be the first baby, they had a birth plan, nothing went right. etc. etc., but we are not stupid. We hate to see a baby who latches on well, and knows how to nurse, suffering because mom's milk isn't in. I've had kids nurse for an hour, and 30 minutes after the mom has left, they are screaming and inconsolable. I call the mom back, and by morning everyone is exhausted. Of course, NO pacifiers. Mom is being used as a paci, because it's the only way the baby gets any comfort.
When a baby latches on, sucks a few times, then drops the nipple and starts crying, it's trying to tell you something.
They may be "caring parents" but I wish they could look at the baby's needs as well as their own.
I agree here too . .. putting a child through a painful procedure rather than feed them anything except breastmilk is ridiculous. It shouldn't be the parent's choice at that point, definitely.
I am really not a nut about breastfeeding. I truly have no problem with bottlefeeding if the mom really wants that. I just want people to have all the information and I'm glad to teach them. What they do after that has to be what THEY find comfortable, not me. As Deb says "It ain't about me". :)
steph
I just think that the docs and mgmnt should convey to the parents that while this is still their child, the NICU , is still an INTENSIVE CARE setting, and for the most part, YOUR PREFERENCES AND "CHOICES" should take a back seat to the expertise and knowledge and (clinical evidence )of those caring for the PATIENT. (who, yes, happens to be your baby) Does anybody else see my point?
There is nothing more gentle on the tummy than breastmilk. I would be highly suspicious of a dr. who stops a breastmilk feed to begin an artificial milk feed because the child has suspected NEC.
Lilpeanut,
My daughter was a 23 weeker and we tried and tried and tried on many occassions when she started feeding to get her exclusively on breastmilk. I wasn't on any meds, I tried completely changing my diet...etc, etc, etc, she just NEVER got to the point of tolerating my breastmilk. So forumula was the way it was. I had pumped and pumped and pumped and had TONS of breastmilk stored that we never got to use. I think I read where you are going to be an NNP. I'm done with NNP school and just have to caution you that there are cases out there where no matter what you try the baby just won't tolerate mom's breastmilk and you have to do formula. It happens. I went through it, I had other moms I'd met while my daughter was in the NICU who went through it and I have patients now who are going through it. As practitioners we understand the importance of BM but there are times when it just doesn't work.
I just think that the docs and mgmnt should convey to the parents that while this is still their child, the NICU , is still an INTENSIVE CARE setting, and for the most part, YOUR PREFERENCES AND "CHOICES" should take a back seat to the expertise and knowledge and (clinical evidence )of those caring for the PATIENT. (who, yes, happens to be your baby) Does anybody else see my point?
I was actually referring specifically to suspected NEC and discontinuing Bmilk to begin formula in that comment. I have read and been told many times that if NEC is suspected, you halt po feeds.
No, mimi, there's not a lot of volume when the baby is born, but the colostrum is packed with good stuff and babies don't need a lot of volume at that point. They nurse constantly after birth to stimulate mom's milk to come in.
I do understand your point, nocrumping, but in non-emergent situations, I do also think that practitioners should strive to keep the parents involved in decisions and the decision making process. If there's a reason you think you should do something that differs from the parent in a non-emergent situation, take the time to fully explain it to them and give them the information of why you want to do X when they want to do Y.
Lactation consultants have always told me that breastfeeding was not more work for the infant. With our premie nipples, it is actually a lot of work for kids to get formula from the bottle. We don't want it to pour down their throats for obvious reasons;) They don't normally get immediate milk from breastfeeding, but that's pretty easy to resolve either by having mom express a little milk onto the nipple before latching the baby or by using a lactation aid at the breast for the first few seconds. I know it is a different type of movement required for bottling, but I didn't think it was "easier" or "less work" than breast feeding. Anyone have any info on this?
That's because lactation consultants will tell you ANYTHING to get you to breastfeed. Some of these moms are so pressured, that they go home and nearly starve their babies to death because they were waiting for their milk to "come in", etc... (it never does, because they dont feed enough, etc, whatever) and they were told to NOT supplement with formula, EVER. They seem to drive this point home real well, but always seem to fall short on actually breastfeeding, like whether the infant is ACTUALLY getting milk.Meanwhile, the bili is through the roof, the kid is dehydrated, miserable, and exposed to multitude of organisms in a NICU, instead of being at home, maybe taking a *gasp*.... BOTTLE here and there of *gasp* FORMULA or ...even expressed br milk, for petes sake. And for the record, it is alot of work to breastfeed. It is a natural way of feeding a child, and I agree it is best, who doesnt, but it is HARD WORK for a baby to learn.. it doesnt come naturally, its a learned behavior. If you put a preemie nipple in a baby's mouth, its there for them, the whole thing, right there, thats by default an easier way to feed, wouldnt you agree? No latch problems, etc... just suck, and milk comes out, NO? Now, if there is a weak suck in any circumstance, that is another issue, with both types of feeding. W e all get the BREAST IS BEST thing. But in a NICU setting, there are LOTS of things to consider. Do I have links on this giving you hard and fast research? NO, I didnt bother to . But I think *MOST* nicu nurses will agree this is COMMON SENSE.
As far as the extended breastfeeding, like til 3.5, even 5 yrs old, as I read in one post.....well, there is no politically correct way of saying what I think THAT is. So I wont say it. But I can say I agree with what someone said, that you can probly find a study showing benefits of bfing til a kid graduates high school, that doesnt mean its NORMAL. And touting intelligence, skills, etc for a kid who breastfed til he was 5 is just asenine, the same can be said for a baby who breast fed till he was 3 months, 6 months, a year old. You can blame "modern sexual views of breastfeeding " all you want, but to me, a CHILD who walks up to his mothers breast at the age, of lets say 3, is NOT NORMAL, in my opinion. To be honest, it makes me shudder. I breastfed my own two INFANTS. I stopped at 1 year. I am not saying this is THE correct thing, and everybody should stop at 1 yr. But, to me, the idea of a walking, talking CHILD suckling on my breast did NOT seem "NATURAL" TO ME. Again, sorry to offend those of you that do that. I just cant imagine it..... being acceptable to some people..... come on, 3-5 year olds??????????????????????????????????
Again, this is always a very hotly debated topic. We're doing a good job of sticking to the topic, not the poster, but beliefs and practices surrounding breastfeeding are very strongly held. Remember you're not going to change someone elses position, just sharing your own. It's great practice for being non-judgemental! (I could put the barfing smilie in here to break up the tension, but I'll restrain myself! )
Many thanks for 'staying cool', guys! :thankya: :yelclap: :loveya:
I believe the information contained within will answer some of your questions. 
t2000JC
159 Posts
I think it's true that there is usually more to a situation than people realize. At the same time, sometimes I think pple don't give nurses and docs enough credit that they really do want to do the best for the baby. And, while some parents have VALID concerns, and we really do listen when they talk about allergies and other issues, we sometimes still have to choose the best of two evils. Hopefully with all of the information we pick the best course of action.
I think NEC is one of those things that happens due to true, early feeds and immaturity, and now we've noticed a relation b/w other txs and NEC too. Aren't some of our formulas super gentle for babies anyway? Forgive me for my ignorance; i just i noticed that if a baby's tummy starts to look suspicious the docs actually may stop breast milk and start alimentum or something. IVs are still a source of infection too, right?
Of course, to add to the mix, each baby is different, so as we always say, it's never a black and white science sometimes, just shades of gray!