larelsail

Hi Steve, I can totally sympathize. I am 4 days away from finishing the final work for my NNP program, and while I have had a lot of support from the nurses where I work, the same hasn't been true in all of my clinical experiences. On my last day of clinical (hour 597 or so), the nurse for one of the babies I was caring for asked how long I'd been a nurse. When I told her 4 years, she nearly shrieked, "Oh my God, only 4 years!! How can you become an NNP with ONLY 4 years nursing experience?!"....and she proceeded to tell me how, as a bedside nurse, she is still learning things after 20 something years. It is such a slap in the face to work as hard as we do, studying, attending class, working full time and fitting in clinical, only to be treated like a fool for thinking that we might advance our knowledge and practice. There is no answer for nurses like that....she would have told me to work another 20 years at the bedside (at which point I would be 47), then go back to school. But, if I got to that point, maybe she'd be the type to criticize and want to know why an experienced colleague would bother going to school so late in her career! I just smiled and explained that the NNP role is different, that I want to complete my education while life is still fairly uncomplicated, etc.....ugggh. Anyway, no advice here, just understanding! P.S. Isn't it ironic that first year ped's residents, who don't even know what CPAP is, get waaay more respect than the second year NNP student with 4 years experience as a NICU nurse!?

"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??

We don't use anything to "clean" the cord...We give tub baths with the cord still on...don't swab umbilical lines (except, of course, when placed)...and our babies have lovely cords!

I love inline suction! Easier, cleaner, as effective as conventional (in my 2 years experience), don't need a second set of hands, quieter, faster...and on and on. Also, our unit has been using inline catheters for giving survanta for about a year...love that, too!!