Hi, folks. I've searched the archives and come up empty; I'm hoping that
someone out there has one of these and would share. The nurses at my
hospital are developing a care plan for pre-term babies under 37 weeks, or
SGA babies under 5.5 lbs./2400 grams, and I have some concerns about what is
being proposed. I work in a Level II hospital so any tiny or sick preemies
get shipped out. We keep babies that are mostly 35 weeks and above,
occasionally a 34-weeker. I believe the nurses are modeling the plan of care
after what is done at our sister-hospital's level III nursery, whose
neonatologists I consider very conservative.
Our general plan of care for breastfeeding babies is pretty relaxed. I
developed a flow chart for the nurses to follow if a baby isn't breastfeeding
that allows babies 24 hrs. to begin feeding before we start supplementing, we
use small amounts of glucose water if mom isn't obtaining colostrum up until
48 hrs., and Nutramigen if needed after that. The pre-term plan the nurses
have developed calls for feeding every 3 hours, by gavage if the baby isn't
sucking, using a pacifier with all gavage feedings, using 24 cal. formula,
and working up quickly to 120 calories/kilo/day. I feel like this is
overkill. I doubt that 24 calorie formula is necessary, and even if mom
obtains colostrum right away I doubt that they'll be satisfied with the
amount. I've thrown out the human milk fortifier once because it's my
understanding it is for much more premature babies than we ever have, but I
suspect it will be showing back up any day now.
So if anybody has an alternative plan, or references to support being a bit
more relaxed, I'd appreciate it. I know there was a presentation at ILCA
last summer on this topic, but there really aren't any references to go with
it. My colleague that was at the presentation has a notation about
"protocols by Kenner in Neonatal Nursing 1998" but if anyone has a more
complete citation I would appreciate it since I haven't been able to find
anything. Thanks, guys.
Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin
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