I work in a level III NICU and I am interested in how others deal with the
term, or close to term baby that comes to the NICU.  These babies may be mild
respiratory distress or sepsis.  Initially all of these babies are NPO and
have an IV.  The normal sequence of events is that as the baby is better the
feedings are started slowly and the IV is decreased.  The conflict occurs
when the baby is to be breastfed.  The Neonatologists are so accustomed to
concrete numbers!!  A usual order would be......"start feedings of 10cc every
3hrs and increase each feed by 5cc as tolerated.  Decrease IV by 1.6cc for
each 5cc feeding increase."  As you can see this does not work with a
breastfed baby.
My plan is to put the baby to breast and if baby latches and nurses decrease
the IV rate in half at each time at breast.  In the NICU we often forget that
these term babies do not require the same amount of fluid therapy as a
preterm infant.  This has become a great conflict in our NICU.  I would like
to hear about other's experiences with this issue.  Presently, many of the
nurses put the baby to breast and then feed the baby formula in the amount to
follow the doctor's order.  I am trying very hard to change this protocol and
need your help.
Debby Menders RNC

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