Hello! I am a new NI nurse and I am looking for information and opinions on any possible connection between stimulation and apnea & bradycardia.
Here's my experience with a couple of babies (all rather similar in their situation)
30 wks, isolette, some RA/some 1L NC, BM gavage feeds, all freq. A's and B's.
Day 1: the pod is super busy and since these babies are generally speaking more stable their hands on is quick: diaper, vitals, assessment at beginning and end of shift, gavage feed while in isolette. Freq. but mild A's and B's requiring slight up in FiO2, or mild stim only. On caffeine.
Day 2: the pod is "less busy" (if that's possible-LOL) So hands on is same as above but the baby is removed from isolette and held for each gavage feed, then parents visit and hold and maybe sibling or grandparents are visiting and hold, talk, etc. Freq. A's and B's and about half of them are more severe/last longer: blow by required and/or mod. stim required.
Clearly, in my experience the two seem to be related. I was "lectured" however, on the importance of holding during gavage feedings for brain development, etc. (which I totally agree with) but some nurses believe that they should be held for all feeds no matter what and always "find the time" to do so. (according to them)
I would like to read more on this topic. There clearly is a limit to the amount of stim. a baby can handle and the babies cues are one way. I just question whether the baby should be removed for EVERY feed, especially if we know in advance that the parents will be in, etc.
I have learned a lot from this group, I hope I haven't left out any important info, but can you share some opinions and experiences on this matter? I really want to find the appropriate mix that is benefitting the baby, without overwhelming them.
Some babies just cannot tolerate being held during feedings! The original post did not say the baby was kangarood , just held with interaction from grandparents, siblings, etc. Kangaroing may have been better tolerated in a quiet, dark environment. We do not generally hold our babies during gavage feedings. We use 5 fr ng tubes and the feedings usually take 20 min - half hour to go in. Who has that kind of time!!! Also if the baby is that fragile, I would save holding time for parents only and let that baby rest while parents are not there.
I think I should clarify my statements a little. Our vitals are hands on q 12. If I am PO feeding a kid I chang the diaper and hold while feeding. If it is on all NG/OG feeds, we dont make a point to hold while feeding. I parents are visiting, they can hold infant if the kid will tolerate it. Or, if tnhey are there during bath time, I will have mom hold while i changhe out the bed. If the kid is with in a few weeks of goping home or a bigger/older kid, or in a bassinet, mom and dad can hold to their hearts content, unless they wake the baby and try and play for two hours...then we explain about sleep, etc. But we also have parebnts who want to reach into an isolette with a 27 weeker who desats when you ope the doors, much less touch him. I dont see the benefit of holding them during all feeds. Mom's hormones are the only ones that effect the kid (and vice versa) so I guess I just dont see waking a sleeping baby to hold him for 30 plus minutes every three hours. Not only that, who has time for it?? The onl one of my kids who ate last night had his feeding go in over 45 min....that would be 4 nursing hours wasted sitting with a baby in my arms!!
Sorry I dont have any hard facts to share, only my experience (which isnt much, I know!!)
What is the baby's adjusted age? How long on caffeine? Are the bradys feeding or holding related since the two are going hand in hand? Could be reflux, low caffeine or you could be right, over stim.
I've never heard that babies should always be held for gavage feedings. Maybe a term or near-term baby, but a preemie? We do as little stimulation as possible. I usually handle all my preemies Q6H to allow them plenty of time for undisturbed rest. I'll do hands-on vitals and diaper with one feed, then the next one I'll do monitor vitals and hang the feeding. I don't disturb the baby at all. No diaper change (unless they have skin breakdown) or anything. I don't even touch the baby. The way I figure, if they're premature, they'd still be in utero and wouldn't be touched or held anyways.
As they get older (like 30+ weeks) I'll offer a pacifier with each gavage feeding to help associate sucking with a full stomach. But I'll still let them sleep undisturbed for 6 hours if possible.
Of course, if the baby is having lots of A's and B's, has a bad residual, has a history of feeding intolerance, etc. - then I'll do hands-on vitals every time and really assess the baby. But otherwise, I leave them alone.
Every unit is different though. I know that some units do a lot more handling than others. We tend to have a large amount of micropreemies (quite a few under 500 grams) at all times, plus a lot of sick PPHN kids. So we're big on decreasing stimulation and are encouraged to handle the babies as infrequently as possible. Other units want full hands-on assessments every hour or two. You gotta do what your unit does, I suppose.
I like your belief, it is one that I have always believed. We do our babies every 3-4 hours, actual hands on. I didn't know that others were touching so much less frequently.
Maybe the "importance of being held during feeds" lecture was misinterpreted from research that parent holding and kangarooing is beneficial during feeds. Babies will respond differently to their parents cuddling them than to a nurse who is only holding because he/she is supposed to. Plus nurses don't do kangaroo care.
There's a big difference between kangaroo care and holding a baby for feeds. Kangaroo care would not involve dressing and removing a baby from an isolette everytime it ate. That would dramatically increase the amount of "handling" and stress. I think this would offset any developmental benefits.
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
Hello! I am a new NI nurse and I am looking for information and opinions on any possible connection between stimulation and apnea & bradycardia.
Here's my experience with a couple of babies (all rather similar in their situation)
30 wks, isolette, some RA/some 1L NC, BM gavage feeds, all freq. A's and B's.
Day 1: the pod is super busy and since these babies are generally speaking more stable their hands on is quick: diaper, vitals, assessment at beginning and end of shift, gavage feed while in isolette. Freq. but mild A's and B's requiring slight up in FiO2, or mild stim only. On caffeine.
Day 2: the pod is "less busy" (if that's possible-LOL) So hands on is same as above but the baby is removed from isolette and held for each gavage feed, then parents visit and hold and maybe sibling or grandparents are visiting and hold, talk, etc. Freq. A's and B's and about half of them are more severe/last longer: blow by required and/or mod. stim required.
Clearly, in my experience the two seem to be related. I was "lectured" however, on the importance of holding during gavage feedings for brain development, etc. (which I totally agree with) but some nurses believe that they should be held for all feeds no matter what and always "find the time" to do so. (according to them)
I would like to read more on this topic. There clearly is a limit to the amount of stim. a baby can handle and the babies cues are one way. I just question whether the baby should be removed for EVERY feed, especially if we know in advance that the parents will be in, etc.
I have learned a lot from this group, I hope I haven't left out any important info, but can you share some opinions and experiences on this matter? I really want to find the appropriate mix that is benefitting the baby, without overwhelming them.
Thanks!
Jenny
You are absolutely correct, that baby should be allowed to rest. I double checked with one of our NIDCAP II certified nurses about the whole "brain development" issue and holding during every feeding. Her response was that developmental care is individualized and if an infant is not tolerating being held every time, then they should be allowed to rest. The NIDCAP guidelines speak to socialization and interaction during feeds. But the baby needs rest to develop above all else.
NIDCAP is considered the authority on Neonatal Development.
Whoa am I glad I stumbled on this thread. I am a student nurse. I work as, what my hospital calls, a "SNA" (student nurse aide). In this position I basically function as a RN. I am allowed to do anything I have been checked off on in school as long as I am enrolledin work experience (I know this will freak some people out but I've been through all the liability debate already). I work in a step down, what we call the NC or ICN. There are no vents, mostly septic kids, some mec. pneumonias and feeder/growers.
So, that being said, here is what is going on. For the last several weeks we have had a 32 weeker born by C/S at 28 wks. because of a previa. I can't remember his exact BW at the moment but he is 1594 gm. as of last night. I had never had him prior to last night because he was being bad and I suppose the RN's didn't want to freak me out. His major issue is feeding desats. He takes all MBM by gavage. So last night mom and dad came in at feeding (super parents- how AWESOME!). I took him out and bundled him up and gave him to mom. Guess what? He was no lower than 98% the whole feeding! SO next feeding I figure.. seems like he liked being out better than in so again bundled him and held him in a corner, facing away from the room, not under any lights and with his bink. He was quietly lookin around and at 99-100%. My senior nurse who has been in the NICU for longer than just a little while told me not to take him out and to reserve all contact for mom and dad (they usually come in every night and some am's). OK that made sense I thought and I felt awful beacuse this was the first smaller and potentially sick baby I had taken care of and I was stressing him out?!
I had thought that his sats and behavior were an indicator that he was happier in someones arms and upright. What do ya'll think?
For the last several weeks we have had a 32 weeker born by C/S at 28 wks. because of a previa. I can't remember his exact BW at the moment but he is 1594 gm. as of last night.
I had thought that his sats and behavior were an indicator that he was happier in someones arms and upright. What do ya'll think?
IMO a 1600 gm, now 32 wkr is a lot more "stable" and generally speaking can handle a lot more handling. Also, it doesn't sound like this baby has had the A's and B's that I referred to....we even start attempting to nipple a baby 32 wks if they are awake and alert enough to try....
My experience was that the babies did not initially have a's and b's during handling (sometimes during feeds, whether reflux or full belly or ?) but that the kiddo was having significant a's and b's/desats while at rest (ie: after handling) that requiring ever increasing stim as the shift progressed and upping the o2 in one kid and blow by in another....
Yes, a kid experiencing progressively increasing episodes could be getting sick/septic also... just don't want to complicate matters with my nursing actions.
To give you my opinion, each baby is different and the interventions and treatment of the baby should be just as individualized...as a new RN I have run into those who question my judgement when caring for my patient and I am wanting to further my knowledge and understanding to benefit my patients and know that I am providing good care.
cshell1964
32 Posts
Some babies just cannot tolerate being held during feedings! The original post did not say the baby was kangarood , just held with interaction from grandparents, siblings, etc. Kangaroing may have been better tolerated in a quiet, dark environment. We do not generally hold our babies during gavage feedings. We use 5 fr ng tubes and the feedings usually take 20 min - half hour to go in. Who has that kind of time!!! Also if the baby is that fragile, I would save holding time for parents only and let that baby rest while parents are not there.