Quote from canoehead
I'm not a NICU nurse, but I understood that intubated pts were always NPO. They are in our ICU (adult), and in the PICU I used to work. Don't they aspirate?
The difference is that when a patient is intubated in the adult or peds ICU, they are usually very sick. If it's going to be long-term, then they're trached and often given a G-tube, right?
In NICU, many of the younger preemies are vented for months before they're strong enough to be extubated. For example, most 24 weekers aren't ready to come off the vent completely for at least a month. They just don't have the strength, maturity, or calories needed to do all their own breathing without puttering out. We can't hold off on feeds for all those weeks or months because they'd have liver damage from the TPN by the time that happened - their particular TPNs have max levels of protein to aid in growth and the healing of their already damaged lung tissue. Once they're past the "sick" newborn period, and are just stable babies who happen to be on the vent, we start NG feedings and slowly work up to full feeds. We try to get their PICCs out ASAP because preemies like to get septic.
We've had kids on vents for months before finally extubating (or going for a trach) and they're usually on full feedings growing very well. No increase in aspiration or anything - why would there be with NG feeds? The only times I've seen aspiration pneumonia is when an NG tube wasn't properly in place, but since we monitor that like hawks it's very rare. I've seen more aspiration with kids on room air or cannulas who pull at their NG tubes, or who have horrible reflux and bottle feed, or a trached baby who they are trying to force into taking oral feeds.
The oral morphine works wonders, and if the baby is older we'll also use oral ativan for sedation. If we need something quick, like if a bigger, post-term baby has no IV and needs intubation, we'll give intranasal versed.
ETA - Just realized the whole "oral" morphine might have been confusing - I mean oral solution as opposed to IV. We give it down the NG.