Dear Lisa,
I liked your reply to Kirsten re premie feedings. This is very much what I
advise as a midwife and former NICU nurse. However some units are not
always supportive of this approach but that is another story.
I am interested in your terminology "Reactive Attachment Disorder". I am
new to this list so may well have missed this previously. I would be
grateful if someone can lead me where I can learn more about this.
Karen Palmer
New Zealand
----- Original Message -----
From: "Lisa Boisvert Mackenzie" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, March 13, 2005 12:30 AM
Subject: premie feedings
> Dear Kirsten,
>
> I am a midwife and a mom who had a 3lb 1 oz, 32 weeker of my own in the
NICU
> (and transitional nursery) for six weeks. I do not and have not ever
worked
> in the NICU. I did a good amount of research when I was in the NICU with
my
> premie in January, February 2003, however, I am no expert nor do I
practice
> in that field of neonatology.
>
> With that being said, I found that little is really known about the
optimal
> feeding and growth patterns of premies in the NICU. Some studies show
that
> fortifier makes for faster growth but is that best for the health of the
> baby? No one knows.
>
> I did kangaroo care "round the clock. Skin to skin. My son was fed by me
> every three hours (I'd skip a night feeding to sleep~ the nurses fed him
> then) at my breast through the NG tube with, whenever possible, freshly
> pumped (not refrigerated) breast milk. The nurses taped the syringe to my
> sweater at my shoulder.
>
> Is this baby's stomach emptying and digesting milk/fortifier/ABM between
> feeds? If not space the feeds farther apart so the stomach has time to
> empty.
>
> Assuming there are no other issues hindering this baby from nursing and if
> this mother really wants to and is motivated to breastfeed:
>
> 1) get rid of the bottle,
> 2) provide kangaroo care with the baby at breast during feeds with the NG
> tube, express milk so the smell is there with the sensation of filling and
> warmth in the stomach
> 3) all feeds through the NG tube
> 4)Stop topping off the bigger child's feeds. Without demand the supply
will
> wane, particularly with twins.
> 5) round up support for the mom (LLL, with stories of BF premie twins,
food
> from friends, whatever might help her)
> 6) remember that premies in the NICU are at risk for Reactive Attachment
> Disorder, keep mom and babes attached!
>
> Warmly,
>
> Lisa Boisvert Mackenzie
>
>
>
>
>
>
>
>
> on 3/11/2005 11:53 PM, LACTNET automatic digest system at
> [log in to unmask] wrote:
>
>
> ----------------------------------------------------------------------
>
> Date: Fri, 11 Mar 2005 20:11:01 -0500
> From: Kirsten Husband <[log in to unmask]>
> Subject: premie feedings
>
> Once again, I need some advice. I don't know what I would do without your
> collective wisdom and experience. I have permission to ask these
questions.
>
> I am working with a mom who delivered twins at 35 4/7 weeks gestation. The
> baby who is causing concern is a little girl--her brother, the bigger twin
> is doing quite well. His feedings are not of much concern---he
> is "practicing" at breast and learning well. The babies are a week old
now.
>
> The little girl had some temperature instability at first, but that has
> resolved.There are no apparent physical or neurological abnormalities.
Now,
> we are having a real struggle getting her to nurse. Mom is pumping and now
> providing plenty of milk which is being fortified. She did skin-to-skin
> with the babies right from the start and continues to do so. The little
> girl, who weighs about 1820 gms now ( gaining)had made some good attempts
> at breast, but tired easily as was to be expected.Right after birth the
> pediatrician ordered supplements after nursing attempts, which were done
> with a cup. That didn't go too well. The mother, about two days later and
> after discussion, decided to offer the supplements with a bottle--and had
> much better success. The pediatrician wasn't quite satisfied with the
> baby's intake and we placed an NG tube too. The order now is to feed her 1
> ounce ( 30 cc) every two hours.( either 22Kcal formula or fortified
> breastmilk). More and more is being fed through the tube as her interest
> in "eating" wanes.
> In the past day or two, she has shown less and less interest in the
breast--
> and even the bottle. She rouses briefly, sucks a few times and falls
asleep
> again. The mom has tried directly at breast and with a nipple shield. The
> baby has a good suck--just cannot sustain it and seems to lose interest
> more and more quickly. Attempts are breast are limited to about 5-10
> minutes.
>
> And now my question. How do those of you working in NICUs handle this kind
> of situation? This baby never has the chance to wake up "hungry". I
realize
> that she needs the calories, and is a premie with somewhat limited
stamina,
> etc. but her very best feeding at breast happened when the "schedule" got
> out of whack, and she was alert and an eager participant.
>
> The mom is patient but getting frustrated. This afternoon she said that
she
> didn't even offer her the breast "because she won't do anything anyway".
> The mom is an RN and understands that her baby has a lot of catching up to
> do, but she is feeling so sad.
>
> Is this a case of wait and be be patient, or is there a better feeding
> plan? The doctor won't let her go home until she is eating well. The twin
> brother is doing OK and taking all his feedings at breast with top-offs by
> bottle as needed.
>
> Thanks for your ideas.
>
> Kirsten, IBCLC
>
>
>
> ***********************************************
>
> To temporarily stop your subscription: set lactnet nomail
> To start it again: set lactnet mail (or digest)
> To unsubscribe: unsubscribe lactnet
> All commands go to [log in to unmask]
>
> The LACTNET mailing list is powered by L-Soft's renowned
> LISTSERV(R) list management software together with L-Soft's LSMTP(R)
> mailer for lightning fast mail delivery. For more information, go to:
> http://www.lsoft.com/LISTSERV-powered.html
>
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
