Even more importantly, little Zachary came off the vent on Christmas  day
after almost 2 full mos!  He's now on a high-flow nasal  cannula.  He is
tolerating full feeds by gavage and gaining well.   He's not quite ready to
po feed due to his oxygen requirement, but she is  looking forward to
hopefully teaching him to breastfeed.  Hopefully her  great supply will make
it easier for baby to get fed at breast.
There is  some concern that the baby has a groove in his palate from being
intubated so  long.  Is that likely to cause a problem?  And any tips on
teaching  a baby that has been so ill to breastfeed?
Jennifer Tieman
Family  Physician
Mom to 4, including my toddler nursling Caroline Rose
 
I certainly concur with as much skin to skin as possible and starting  
Zachary breastfeeding on an almost empty breast with a 16 mm nipple shield.  Nasal 
cannula oxygen should not, in and of itself, keep him from breastfeeding  
unless he is in such respiratory distress that he is very unstable. Non  nutritive 
sucking should not distress him. One thing about breastfeeding, unlike  bottle 
feeding, is that you cannot force a baby to do it. If he is not  ready he 
just plain won't suck. Mom can be taught to watch his cues and the O2  sat 
monitor to make sure he is not being overstressed. I usually start tiny  babies with 
one session per day with no real emphasis on nutrition.  The  grooved palate, 
secondary to the endotracheal tube, can be a problem. These very  tiny babies 
who have been intubated have narrow palates and marked grooves and  although 
they latch, are sometimes unable to milk the breast adequately.. The  huge 
supply your friend has, Jennifer, can do much to overcome this, becaues  along 
with this oversupply will be fast easy flow--sort of like using  a red premie 
nipple on the baby. At first mom may be very frightened of  breastfeeding a 
small, fragile baby so it is helpful if you could sit  with her through the entire 
feeding seesion, helping with latch and position and  reassuring her that you 
will keep the baby safe. Also, these small premies  frequently hold the 
nipple in their mouths for 5-10 minutes before they ever  start sucking. I find 
when they are totally comfortable and have regulated  their breathing, 
temperature, etc. to mom they begin to suck. Positioning is  very important because a 
premie cannot readjust--make sure the chin is well  tucked and body is wrapped 
around mom in cross cradle with baby's bottom in her  elbow. The nipple shield 
will stabilize the nipple in the baby's mouth--wetting  the edges to "glue" it 
in place for mom is helpful.   Good luck!
 
Kathy Boggs, RN, IBCLC 


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