In a message dated 4.1.02 12:03:39 AM,Teresa writes:

>Just a question about this - why the requirement that the baby must
>> take all
>> feedings by breast or bottle? We ran into this when my grandson was in
>> the
>> NICU and he was being breastfed then "topped up" with EBM by gavage.
>We
>> wanted to try using a tube at the breast to give him the extra milk and
>> felt
>> we could take him home feeding that way, but the pediatrician was
>> insistent
>> that the baby had to have all feedings from either breast or bottle.

then Anne responds;
>>In certain circumstances, some babies will go home with the parents
taught to gavage feed. An example might be a baby with neurological
deficits who is unable to suck well either at breast or bottle.

Tube feeding is not risk free though, and I would not be comfortable
sending a baby home still needing tube feedings, though I know some
units do that.<<

I don't think that Teresa was suggesting gavage feeding at home. My
understanding of her question was whether an SNS (or similar system) could
provide the same benefit.  The SNS STILL requires the baby to suck and
swallow where the gavage feeding does not. Thus the thought is if the baby is
"too tired" from po feeding to ingest adequate cals for growth, it is too
soon for the baby to be discharged. Very often this "immaturity" in terms of
feeding persists in other areas as well. In other words a premie who can't po
feed quite well enough may also persist with occassional episodes of apnea
and bradycardia and/or difficulty coord. suck/swallow etc.  During my time in
the NICU, it wasn't very often that a baby was ready for d/c in all other
areas except for feeding, IF they were supported adequately along the way.
Teresa, in regards to your Grandson and "topping him off" the first ?? is;
did he in fact *need* that extra for as long as he was getting it. This could
be an example of where inexperience with brfdng. in the NICU becomes the
issue whereby the HCP making the feeding decisions can't weigh all of the
variables and wean from the suppmt at a rate consistent with the baby's
abilities and Mom's ability to produce milk.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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