Hypothetical feeding question.

nicumom · Apr 23, 2007

We would continue the feed unless these events continue

preemieRNkate, RN · Apr 23, 2007

Has the baby been R/O for GER? Our docs would probably start the baby on something for that since the baby is already on caffeine and the episodes occur with feeds. To answer your question though, for an episode requiring vig stim to resolve I would continue feedings, but I would be bugging the docs ASAP to find out what the heck we were going to do. For an episode requiring PPV, I would stop the feeding and really bug the docs.

dawngloves, BSN, RN · Apr 23, 2007

I'm more concerned with circulation to the gut.

SteveNNP, MSN, NP · Apr 23, 2007

I don't think that the gut could have gotten too hypoxic with a 15 second episode...I would crank the head of that bed way up, and watch that kid like a hawk during his next feed. Any problems, I'd stop feeds and call the doc.

prmenrs, RN · Apr 23, 2007

I think you're wise to be concerned about the gut and it's circulation (or lack thereof!).

THe baby has this events regardless of being fed or not? You said it happened a couple of times/day. S/he seems to be vagal-ing for some reason. You could try graphing the day--feedings going from x-time to y-time, events happened @ y-points. See if there's a relationship or not.

If you have continous feeding and the baby still does it, maybe it's not related to the feeding. Is she refluxing? That would sure cause a bad vagal like you're describing.

Don't know if this is still in current practice, but we used to do NJ feedings--pass the tube thru the duodenum, run the feeding over 2 hours, one hour off til the next feeding. They can't reflux cuz there's nothing in the stomach, and they vagal a lot less.

I don't think I'm answering your ??, just throwing random ideas in--most of which you've probably considered.

Let us know what happens.

dawngloves, BSN, RN · Apr 23, 2007

Mind you, this is a therory. Not one particular pt. Just something I pondered last night.

I'm considering the fact that maybe brady's (greater than 15 seconds requiring vigorous stimultaion or even PPV) during or after feeds would contribute to NEC due to lack of stimulation to a gut with food in it.

Not really worried about the cause. :lol2: Just tossing out food for thought.

Jolie, BSN · Apr 24, 2007

dawngloves,

I agree with your concerns, and have wondered the same myself on the horrible occasions when a previously stable feeder-grower near discharge has suddenly become deathly ill with NEC.

I just don't know of any practical solution feeding-wise when a feeder-grower exhibits these extreme A/B spells. Do we make them npo for 24-48 hours? That would involve risks of IV or PICC access, interfere with their learning to suck, swallow and breathe, and decrease the calorie, fat, and protein intake so crucial to their growth and healing. Also, how do we determine the appropriate length of time to make them npo?

Lots of good questions for discussion and research!

Gompers, BSN, RN · Apr 27, 2007

Very interesting topic. We wouldn't discontinue feeds, but I often worry about gut circulation in kids that brady that much or that low. I hate it when we have feeder-growers who are having bradys and have low hematocrits -yet the docs don't want to transfuse. I understand about wanting the baby to retic on his or her own, but I shudder every time I see a flowsheet full of bradys and desats because I wonder how smart it is to pump a gut full of food when it's most likely being compromised. If blood shunts away from the gut first, how can we deny this theory?

I really think you have something here. Think about it - don't you guys notice that when babies who are on full feeds get NEC, it's often overwhelming and much worse than a little micropreemie who is NPO or just on tropic feeds? We rarely lose the little ones to NEC, but more than half the time if a 30-something week grower-feeder gets NEC, they're dead by the end of the day. If we continue to feed babies with frequently compromised guts, we're really playing with fire, in my opinion. Definitely something to think about.

Gompers, BSN, RN · Apr 27, 2007

I agree with your concerns, and have wondered the same myself on the horrible occasions when a previously stable feeder-grower near discharge has suddenly become deathly ill with NEC.
I just don't know of any practical solution feeding-wise when a feeder-grower exhibits these extreme A/B spells. Do we make them npo for 24-48 hours? That would involve risks of IV or PICC access, interfere with their learning to suck, swallow and breathe, and decrease the calorie, fat, and protein intake so crucial to their growth and healing. Also, how do we determine the appropriate length of time to make them npo?

There we are again with the trend of severe NEC with grower-feeders!

Also agree that making them NPO isn't the answer. I personally think that the best way to deal with this problem is to find out what's causing the bradys and desats, then treat THAT. If the kid needs blood, GIVE THE BLOOD! If the kid has reflux, start/change/increase dosage of meds. If it's central apnea, start/increase dosage of caffiene. Get a sleep study, a swallow study, an upper GI, a pH probe, etc. if this trend continues despite intervention. Treating the underlying problem seems to be pretty simple logic, but it's amazing how docs sometimes want to "wait and see" even though there are so many things we can do to help relieve the problem...

dawngloves, BSN, RN · Apr 27, 2007

There we are again with the trend of severe NEC with grower-feeders!
Also agree that making them NPO isn't the answer. I personally think that the best way to deal with this problem is to find out what's causing the bradys and desats, then treat THAT. If the kid needs blood, GIVE THE BLOOD! If the kid has reflux, start/change/increase dosage of meds. If it's central apnea, start/increase dosage of caffiene. Get a sleep study, a swallow study, an upper GI, a pH probe, etc. if this trend continues despite intervention. Treating the underlying problem seems to be pretty simple logic, but it's amazing how docs sometimes want to "wait and see" even though there are so many things we can do to help relieve the problem...

Heck yeah! It drives me crazy when a Hg is 8 and the docs are all like, "It's OK, they're reticing." Waitn it out isn't such a good idea in the long run. :uhoh21: