Hi again all, I just wanted to write in response to the message (and vent a little myself)
Tue, 1 May 2001 21:31:03 -0700
From: Venus <[log in to unmask]>
Subject: Necrotizing enterocolitis
"She's absolutely livid, since she's convinced the formula is what caused the NE, "
Having worked an NICU, or Special Care NSY for the last 20 plus years, I must congratulate this mom on her discovery. For years doctors and researchers have strive to fine the one cause, of NEC and here this mom seems to have done so in just one day. Now I may sound a little miffed here, but come on folks. The cause of NEC is suspected to be caused by "numerous" things. No one bacteria, food, ect. has been singled out.
Let me say that I am very pro- breastfeeding, in fact I currently work in an NICU and am striving to get ALL our moms to supply their milk for their babies. Some of babies weigh only 400-500gms (that is less than a pound -pound and a half). Our neonatologist are very positive also to breastfeeding. The benefits to these and all infants are well documented. BUT, ALL babies need a certain number of calories to sustain life. Now I am not in this particular unit, but visualizing the story in my mind I can get a good idea of the admission and the routine used in these situations. Basic admission includes Lab test, NPO (nothing by mouth) for a number of hours or days (depending on their condition), assistance in thermoregulation (keeping warm) on a radiant warmer or isolette and close monitoring. And I must ask myself this question "what was the cause of preterm labor, if any and what is mom's prenatal history?
We all like to think that our pregnancy will come out just like we planned. But real life does not always follow our plans or wishes. Yes mom may have made all these plans for full term or closer to tem babies, but as many a parent can tell you, you don't always get your wishes.
Now that I have vented a little, I would like to add a little research information " Handbook of Neonatal Intensive Care" by Merenstein and Gardner. This is just one of many books in my home library. I just put my hand on this one first but it may give a little insight to NEC for non-medical, non-NICU folks.
NEC: Etiology is unclear and mulitfactorial. 3 mechanisms suggested as pathogenesis 1) intestinal ischemia, 2) bacterial colonization, 3) enteral feedings. Onset is usually between 3-10 days of life. Incidence: 1-10 % of all admissions to the NICU; approx 90 % of cases occur in preterm. Sporadic and in clusters.
Now mom may have latched on (no pun intended) to # 3 and be partially correct, but ask your self this, if it was just the formula, why didn't the other twin get NEC? Yes "Breastfeeding may be partially protective" but look at the other causes. If the infants required O2 then they were susceptible. Is it possible that the staff ran out of breastmilk / colostrum, since she was feeding two? Nurses are people too and do make mistakes. Do you want to Crucify them all? I understand Kathleen's vent and concern for a dear friend, but the doctors and staff are also (I assume) concerned for her friend's twins. Remember "Preterm infants do not follow the Normal pattern of Full term infants".
I hope and pray that her infants will come through with a positive course of care and be able to come home soon. But part of our jobs as nurses is also to understand the stress and strain of parents and the extended family that comes with having babies in the NICU. Perhaps a sit-down talk with the doctors will not alienate the doctor but maybe give him a chance to help mom and family understand their infants care. Who knows if approached right "everyone" might learn something.
Well that is my 2 cents worth. God bless us all who work with mom's and babies.
Ann
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