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.
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.
This one passed away. He was doing so good when I had him..honeymoon pd was over I guess and ...aw, I feel so bad for the dad..he was so proud of his only boy.
Specializes in PICU, ICU, Transplant, Trauma, Surgical.
From nothing to 2mL Q3 seems awfully quick to push a 700gm'r.
We start trophic feeds, 0.5mL/hr continuous. Work up the volumes then we'll do __mL (based on wt/cal. need) TRO 3hrs, then no feeds x1 hr. Then we'll have it TRO 2hr, off x2 hr. Then start bolusing the feeds - ___mL Q3H. As the baby tolerates of course.
It always scares the crap out of me starting feeds on itty bitties like that. Because of the threat of nec
Specializes in PICU, ICU, Transplant, Trauma, Surgical.
The 22 weeker (520 g) I´m taking care of right now is 5 days and on full feeds since yesterday.....
Anna
That's the kind of stuff that makes me nervous. We've had a ton of Nec incidences lately as well. Scary perfs and all. I don't know what the deal is. We're all on high-alert in our unit though.
That's the kind of stuff that makes me nervous. We've had a ton of Nec incidences lately as well. Scary perfs and all. I don't know what the deal is. We're all on high-alert in our unit though.
We've had a lot of perfs on our unit lately. Only on the micros. And none of then had ever eaten yet when they perfed. Very strange.
Specializes in Level 3 NICU 17 yrs, Neo transport 13 yr.
We start trophic feeds on the micros (DOL varies) at 1 ml q 12 hrs then if tolerating will increase to 1 ml q 6 hrs. Some docs will then increase volume to 2 ml q 6 hrs and some will go with 1 ml q 3 hours. Knock on wood, we haven't had many cases of NEC in the past few years.
Our hospital start with trophic feeds of 0.5 -1 ml Q8 hrs....breastmilk preferred. We push early feedings and advance, as tolerated, fairly quickly. Our IV days have decreased with our sepsis rates also decreasing. We have had 1 case of NEC, requiring surgery, in the past year. Times are a changing....and I think for the better (although, I might not have thought so in the beginning!)
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
Current studies support this method of initiating feeds with micro premies. Early on, increasing to full feeds quickly as tolerated and with breastmilk or BM with human (not bovine) HMF and no formula.
I'm at a NICU conference and when I return and digest all this new, great info, I can post more on the latest data and findings if anyone is interested.
only 2 days past recieving Indocin
You can resume feeds within hours after giving Indocin.
"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....."
I think that is awesome!
So, I am currently working on finishing up my master's thesis on probiotics and NEC prevention, and have been doing a lot of reading and thinking about NEC lately.
I think the Swedish approach might work because instead of giving the baby a few days to become colonized with potentially pathogenic NICU bacteria (which is what studies show happens in our NICU preemies), they are almost immediately promoting colonization with the beneficial bacteria in breast milk. The most recent theory I have seen is that the 3 components necessary for NEC are potentially pathogenic bacteria, enteral feeds and an immature gut, and not necessarily the ischemic insult that we have thought of in the past.
I am curious, Anna, are you using probiotics in Sweden (Lactobacillus or Bifido?) And are you using banked breast milk for those early feeds? If so, is it pasteurized? I wonder how that would affect its beneficial properties??
I am curious, Anna, are you using probiotics in Sweden (Lactobacillus or Bifido?)
I'm curious about this too. There were only two countries mentioned that were initiating probiotic use. I think China and maybe Norway...? UC Davis is/will be conducting a study on the use of pre/probiotics.
And are you using banked breast milk for those early feeds? If so, is it pasteurized? I wonder how that would affect its beneficial properties??
For micros, we usually wait at least a week. Sometimes a bit more. First feeds are normally 1 ml q 12 for a few days. If mom is attempting to express/pump breastmilk, our ARNPs usually wait until we have breastmilk (our doc's don't usually wait though). As everyone knows, breastmilk is much better and even has healing properties for the gut.
For micros, we usually wait at least a week. Sometimes a bit more. First feeds are normally 1 ml q 12 for a few days. If mom is attempting to express/pump breastmilk, our ARNPs usually wait until we have breastmilk (our doc's don't usually wait though). As everyone knows, breastmilk is much better and even has healing properties for the gut.
Hopefully this will change soon. Two of us transport nurses and an ARNP from our unit (TGH) attended the conference.
NeoNurseTX, RN
1,803 Posts
This one passed away.
He was doing so good when I had him..honeymoon pd was over I guess and ...aw, I feel so bad for the dad..he was so proud of his only boy.