Nancy said,
<< And, if it is breastmilk, at least the aspiration isn't as likely to be as
much of a problem as if it were formula."
Please give me a reference, in humans or primates that confirms this - I
would love to have it!>>
I'm sorry -- don't have chapter and verse on that, but I do know I've seen it
in reference to TEF and the age old practice of giving sterile water before
allowing the baby to breastfeed -- and then the statement that colostrum was
less irritating than sterile water. (Which I then morphed into
colostrum/transitional milk being less irritating than formula.) Can someone
else help me out here? Not sure I could give a reference r/t primates as I'm
not sure how many routinely receive formula....
<< We ARE concerned about vomiting and aspiration at all times! But babies
are
less likely to do it if they are in their parents arms, and crying in pain!
>>
I know we are concerned about aspiration in babies -- but it seems to me in
hospitals there's a really cavalier attitude about it -- babies spit. And
mostly what I see is babies in cribs, not in parent's arms. And with all the
circs I've assisted with, I didn't see vomiting then. I saw more
vomiting/spitting/urping (whatever you want to call it) at times when baby
was quiet and in the crib -- totally unrelated to circs, crying, or anything
else.
But maybe I just got lucky.
How would you handle the unscheduled aspect of circs? Keep babies NPO the
morning of the day it was going to be done because it was being done between
deliveries and office hours, and one never knows when the doc is going to
show up -- or how many he has to do (we do 3500 deliveries a year, so any
given OB might have one or 6 circs to do in any given day).
In the 17 years I've been working at this hospital, we've never had a
problem, and my guess is that 95% of the boys delivered here are circumcised.
And there has never been an NPO policy in the 17 years I've worked here, for
either breast or bottle fed infants. Occasionally someone will say, "Oh, he
just ate," and usually someone else will say, "Oh, don't worry about it."
What about keeping them NPO before a heel stick for the PKU etc -- which
involves pain and crying?
Is it the fact that the circ is surgery that causes the problem, or is it, as
someone suggested, when we use general anesthesia that causes nausea which
leads to vomiting?
I really want to get a handle on this, because I can think of a lot of
surgical types of procedures that you don't have to be NPO for -- minor
procedures, such as removal of ingrown toenails, cryosurgery, and so on.
what is it that predisposes someone to vomiting? Is it fear? Pain? Nausea?
General anesthesia? Local anesthesia? Traditionally we have kept women NPO
during labor because they MIGHT have to have a C/Section for which they MIGHT
have to have general anesthesia for which they MIGHT vomit and aspirate (just
in case OB). In the birthing center we told women they were free to eat
whatever they wanted to whenever they wanted to throughout labor, and we had
much less nausea and vomiting, and moms had a lot more energy than the moms
in the hospital who were kept NPO except for a few ice chips or sucks on a
wet washrag (ugh).
Perhaps my real question is: are we keeping babies NPO for circumcisions --
and moms NPO in labor because we have good, solid, evidence based research
that this is BEST for the majority of humans, or because of a theoretical
possibility that something may happen -- tradition based medicine?
And since formula takes longer than breastmilk to be digested, and the baby
(in the first couple of days) who is being formula fed, generally gets more
formula than the breastfed infant, shouldn't we keep that baby NPO longer
than a breastfed infant if we are concerned about potential aspiration during
the circ?
I'd really like to know. Do we have ANY literature, supporting one notion or
the other?
Jan Barger, RN, MA, IBCLC
Wheaton, IL
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