Do you give breastmilk/formula/glucose to vented patients?

[Sweden]

I read a thread in the MICU/SICU forum about giving ice to intubated patients and started to wonder how other units handle this.

My unit encourages and allow us to give small amounts of food with each feeding (preferable with the pacifier). Glucose are allowed to all patients including the intubated or NPO patients.

Do you give breastmilk/formula/glucose to intubated patients?

Anna

[Sweden]

You mean PO? We've given glucose on a pacifier, but that's it. How would they swallow anything else?

Yes, I do mean PO. I´m not talking about lots of food, simply a few drops each feeding. A bigger/older vented patient (alert and awake!) could get more as long as I see that the baby swallows without problem.

To answer the question everyone else thought I was asking.....

The norm here is to start NG/OG feedings within 2 hours of birth. That is done regardless of the babies need for help with his/hers ventilation. The 23 weeker (7 days old) I took care of today was on full feedings, no iv drugs or infusions.

Anna

[FlyingScot, RN]

I'm thinking the babies in Anna's unit are probably nasally intubated (pretty common in Europe) and may even use cuffed tubes which would explain how giving them PO fluids would work. In our unit oral intubation is the norm and would make it extremely difficult to allow for this. They do get their pacies dipped in Sweetease which we fondly refer to as "Baby Crack". Also, we start babies less that 1200 grams on what we call "base solution" while on transport. I'll have to check the actual makeup but it's basically a D10 and Trophamine custom mix. No MVI initially. Gut stim feedings as well especially on the little ones.

[juliachloe]

Full feeds at 23 weeks? Is this at the very least half-strength breastmilk? I thought all of the research out there indicated that advancing feeds too quickly posed great risk for NEC? Our unit is notorious for feeding too much too quick & we've got lots of NEC. To add to it they'll start kids out at 24cal. I'm interested to know what kind of feeds he/she is getting. And if I'm behind on my research knowledge someone please let me know.

[LilPeanut, MSN, RN, NP]

Actually, I think the reg bm would be better than altering it by cutting it or adding to it. Part of the risk of nec is hyper or hypo osmolity. since BM is perfectly formulated, you don't have that problem.

and yes, we feed vented kids constantly - og/ng/gt.

I appreciate the desire to extubate asap, I know we just extubated a 23 weeker to bubble cpap, but then 2 hours later almost lost him before we got him reintubated.

[Sweden]

Áll intubations are done orally at my unit, but I don´t see why that would be an issue (I mean compared to nasal intubation). They are never cuffed!

I have to remind everyone that I´m talking about small amounts of food, not drowning them in it! What they don´t swallow themself is removed either by suction or just by a little gauze (sorry, don´t know if that´s the right word).

It seems like some think it´s ok to give a little glucose PO, but what´s the difference between that and milk?

Ok, back to the other side of this thread......

We try to get all babies on full feeds (all preemies are given breastmilk, mothers own or donated) as soon as possible and ofcourse we watch out for NEC while doing so. We (Sweden and Scandinavia) have really good results and our incidence of NEC is actually quite low.

Anna

[FlyingScot, RN]

Yes, I do mean PO. A bigger/older vented patient (alert and awake!) could get more as long as I see that the baby swallows without problems.Anna

I'm confused now. How do you nipple a baby who is orally intubated or do you just syringe it into their mouths? I'm thinking the tube would get in the way. Also, there is the beginning of a paradigm shift and some units are starting to use cuffed tubes even with neonates. The cuff is inflated until the airleak is just lost. Mind you most of these are used on term babies but we have cuffed tubes all the way down to 2.5. I was a surprised as anybody because for the last 20 years it has always been no cuffs under 8 years old but apparently that is going by the wayside. That's the thing with neonatal medicine...never say never because the next thing you no they rewrite the rules.

[Sweden]

I'm confused now. How do you nipple a baby who is orally intubated or do you just syringe it into their mouths?

We don´t nipple the baby, that would not give me the control I need to make sure the baby doesn´t take more than it can handle. I give a little with a syringe when he/she is sucking on the pacifier/tube.

Using cuffed tubes sounds like a really bad idea, but then again, it wouldn´t be the first time in nicu history we change something major after new research results .....

Anna

[RainDreamer, BSN, RN]

You guys, she's not talking about giving the WHOLE feed via PO .... she just means a drop or two, like you would give sucrose to a vented kid.

We sometimes give sucrose to vented kids, but I haven't seen EBM/formula given like that .... but I don't see why it couldn't be.

As far as feedings/NEC ..... we start feeds right away and increase as tolerated (pretty quickly). We don't have many cases of NEC. But if there is any kind of suspicion of NEC they will stop feeds right away and then re-start/increase with much more caution. I've seen research that shows if you don't start feeds soon and don't increase, then that could really increase the risk of NEC even more so than starting feeds too early. Gotta get that gut moving. I find it fascinating that in Sweden they have 23 weekers on full feeds like that, wow .... and such a low incidence of NEC, that's awesome!

[elizabells, BSN, RN]

We usually don't feed on vents either. I think it's because we use CPAP so heavily that if a kid is intubated it's because she's REALLY sick. Once in a while we'll do some trophic feeds via NG on an older kid who's intubated, or if the baby has a GT.