micro preemie trophic feeds

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How do you all do your trophic feedings?

ie; continuous feeds, q3 so many mls per gram etc?

We had a 670 gram preemie getting 2 mls q3...had no residual for full 12 hour shift, girth stable, no color change in abd etc...then first feed for night shift? 4.5 ml residual, bilious....black tummy 8 hours later....out to surgery for NEC reduction to bowel :(

One doc, mad at the other doc for ordering the feeds so soon. Baby was 5 days old, only 2 days past recieving Indocin, and despite nurses questioning the orders, doc insisted upon trophic feeds...

Just curious how other places handle their trophic feeds.

Thanks all,

Christine

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Specializes in NICU.

For the most part, we usually don't start feeds until the UAC is pulled. For the micros that are behaving themselves, we might start some trophic feeds (after Indocin) while the UAC is still in. 1ml q6h is generally what we begin with. Then advance to 1ml q3h, and then advance according to tolerance and weight. Usually the micros aren't stable enough to start feeds until after their UAC had to be pulled anyway.

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Specializes in NICU.

Before last week, it had been a really long time since I'd had a fresh micro...well i had a 26 and change weeker on cpap eating 2 ml q 3 hrs and doing great. Twin had some green residuals so was NPO. I don't think we ever do q 6 or q 12. You're either q 3 or NPO. And yes we have a lot of NEC...

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Specializes in NICU.
Before last week, it had been a really long time since I'd had a fresh micro...well i had a 26 and change weeker on cpap eating 2 ml q 3 hrs and doing great. Twin had some green residuals so was NPO. I don't think we ever do q 6 or q 12. You're either q 3 or NPO. And yes we have a lot of NEC...

Ya know....I am from the old school. What is the big hurry to start feeds? I just don't get it. We may start with Q4 or NPO......and yes we have alot of tummy issues too:banghead:

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Specializes in NICU.

We see so many micros come in with tummy issues on my unit that were fed trophic feeds, so I get a negative feeling towards them, but I suppose I don't see all the ones that do turn out well. I'm curious on this though-maybe will have a look around PubMed.

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Specializes in NICU Level III.

had a 24 hour old 24 wker, 770g today..started feeds of 2 cc ebm or ssc 20 q3.. yikes. i have noticed a TON of NEC lately where i work but i don't know if it's because of the high acuity and/or high census..or what.

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On rounds one day, they told us that studies show it NEC rates do not increase when preemies are fed earlier... I don't know about that..

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Specializes in Neonatal ICU (Cardiothoracic).
On rounds one day, they told us that studies show it NEC rates do not increase when preemies are fed earlier... I don't know about that..

No... the studies are actually showing that early initiation of feeds does NOT increase the risk of NEC. Anecdotally, it may not seem like it.

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Specializes in NICU.
had a 24 hour old 24 wker, 770g today..started feeds of 2 cc ebm or ssc 20 q3.. yikes. i have noticed a TON of NEC lately where i work but i don't know if it's because of the high acuity and/or high census..or what.

That's because our docs like to feed. We already feed more often than other hospitals do (q3 or npo vs q6 or q12). If they're tolerating q3, then they'll come and advance feeds almost daily so that you have these 800 gram kids on full feeds (~19 ml) by the time they are 21-30 DOL. And then the nurses run it over 30 min, which is a bit fast for someone that small eating that much IMO. Then the NEC sets in with "no warning". Duh... :yeah:

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Specializes in NICU, Med/Surg.

We usually start their first feedings within 2 hours of birth (regardless of gestation age) and advance as tolerated. Most are on full feeds within a week (

We have a low incidence of NEC in Sweden so it seems to work....

The 22 weeker (520 g) I´m taking care of right now is 5 days and on full feeds since yesterday.....

Anna

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Specializes in NICU.

We sometimes start as low as 0.5mL q6h for micros. More often, we have bigger preemies who start at 0.5mL or 1mL q3h.

One of our docs feels very strongly that green residuals are not an indication that a kid needs to be NPO if he is clinically fine otherwise. The trophic feeds are to get the gut stimulated, and this will result in the production of bile. When we check residuals, we are really pulling out that bile, which is supposed to be green.

We do sometimes have kids end up NPO, but in the very beginning, we do spend a little time discarding the green and continuing to feed. And our NEC rates aren't high...although one case of NEC is too many IMO!

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