1) For premies, when do you start feeding them? Day 2 or 3? I know that if you feed them starting day 1, they can get NEC. In the meantime, do you start TPN? Or is TPN only if the baby is going many days without eating? What kind of IVF do you like to use? D10W + NS or 1/2 NS, + KCL, + Ca?
- We start feedings within 2-3 hours of birth, D10 and/or TPN is started as soon as possible (if the baby isn´t on full feeds from the start ofcourse).
When you start to feed premies, do you have to slowly advance it, or do you just immediately give them feeds that would have them at 100 kcal/kg/day?
- Some are full feeds right away (usually GA > 30 weeks), others advance their feedings as soon as they tolerate it.
2) How much spit up do you tolerate before you decide that either medication or NG tube needs to be used? Do you not care as long as they arent aspirating, brady, apneic, choking, and gaining weight appropriately?
- We tolerate spit up as long as the baby otherwise is doing ok and gaining weight (spit up is ok, puking all the time isn´t). Medications for gastric reflux is really uncommon, we don´t see much gastric problems.
3) Do all/most premies get OG/NG even if they have no feeding/airway issues?
- No, we try to avoid OG/NG tubes if it´s not absolutely necessary.
4) How do you adjust feed schedule if the baby is on a vent?
- Vented patients are fed the same way as all others (bolus fed every 2 hours). The ventilator is not a considered much of a factor when deciding feeding.
5) How much weight is a baby supposed to gain each day? Like 10g or so?
- That entirely depends on the baby (GA, condition, current weight and so on).
6) When you start human milk fortifier? Only if the baby has had several days of BM with poor weight gain? Or does every premie get HMF regardless of their weight gain?
- HMF is usually started after about 2-4 weeks if he/she isn´t gaining enough weight on just breastmilk (we can go up to 220 ml/kg/day depending on baby´s condition).
7) All these babies are supposed to lose weight for at least the first week regardless of what you feed them, correct?
- All babies loose weight, we try to keep it