I also agree that the study group is the biggest part of the problemand this
includes the rest of the people in the equation. Neonatologists do not
routinely feed babies or weigh them. Neonatal nurse practitioner do not do
this either although they may have done this in the past. In big NICU's,
the staff nurse does not often feed premies either. "Feeders and growers"
are sent to a step-down unit until ready for discharge from the hospital.
I find that some staff nurses are not very skilled at test weights for a
number of reasons. One reason is that they will do test weights with the
monitor cable attached and that will make for an inaccurate weight. When a
NICU staff nurse performs the baby's daily weight, she must do it with IV
lines, chest tubes, endotracheal tubes, nasal canulas, etc all attached.
Test weights are often very inaccurate with tubings attached to the baby. I
have found that it is more accurate to do test weights on babies that can
have the dangling tubes removed for weights.
The scales used for daily weights are not as finely calibrated as the test
weight scales. The scales that we use to do daily weights are weighing in
10-20 gram increments instead of the 1-2 gram increments that the test
weight scale uses.
I hope that this provides some additional info for your talk, Susan.
It is finally raining here in Minneapolis. We are several inches behind in
rain fall this year.
Have a nice day, Rachel Wahl RN IBCLC
>From: LACTNET automatic digest system <[log in to unmask]>
>Reply-To: Lactation Information and Discussion
><[log in to unmask]>
>To: [log in to unmask]
>Subject: LACTNET Digest - 7 Jul 2007 to 8 Jul 2007 - Special issue
>(#2007-525)
>Date: Sun, 8 Jul 2007 15:27:40 -0400
>
>>
>Date: Sun, 8 Jul 2007 12:06:22 -0400
>From: "Catherine Watson Genna, IBCLC" <[log in to unmask]>
>Subject: Re: The dribble from bottles and the wiggle in test weighing
>
>The study population is probably the important issue here.
>Neonatologists usually work with preterm infants, or very ill infants,
>who have undeveloped aerobic capacity for feeding, and stressed or
>immature neurological control of the coordination of swallowing and
>breathing. These babies can spill a tremendous amount of milk from their
>lips in self defense when bottle fed the traditional way (laying down
>with the bottle upright) particularly when artificial milk company
>nipples (which are particularly fast-flowing) are used. That red
>"premie" nipple is the worst, it's a firehose!
>
>Lactation consultants who understand flow issues can usually bottle feed
>a baby without any spillage, by sitting the baby up and holding the
>bottle horizontally so the nipple is only half full of milk (and the top
>half is full of air). This neutralizes the flow and allows the baby more
>control. Air if pushed out of the nose by the soft palate right before
>the swallow, so the air is not swallowed in well controlled swallowing.
>If the baby has to gulp, then this doesn't happen efficiently, and the
>air winds up in the stomach.
>
>Catherine Watson Genna, IBCLC NYC
>
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