Kathleen et al, answering the NEC question,

Kathleen, in the quote after your signature, there is a line that says,
"Don't make assumptions."  I think that applies here. We all feel that the
fact that the nurse(s) didn't find out if the Mom had colostrum available
was inexcusable. We all know that colostrum is the best thing to line the
gut with and greatly decreases the chance of NEC and lots of other things.

What we don't know is if this infant already had NEC going on from some
incident in utero. Premies, and multiples in particular, suffer many insults
in utero that we may never know about, unless one comes up with a problem.
It is entirely possible that an area of that twin's gut had decreased
oxygen/perfusion at some point(s) in time in utero due to some unknown
physical stress, which led to ischemia in the area and subsequent breakdown.
Now the situation must be closely monitored by those at the bedside in hopes
of preventing further damage.

The Mom should, of course, continue to make it known that she wants
breastmilk used as soon as is possible, and ONLY breastmilk. It should be
passed on in report daily so it doesn't get missed again and written on the
Kardex if they use those.

I know these twins were not very premie, but they still have risk factors. I
think most of us who have worked in NICU's have learned to hold our breaths
even when "everything looks fine" with premies, because we understand there
are lots of things we DON'T know about these little ones. If we don't do our
jobs well, babies can die.

This Mom, and others in her situation, will benefit from a strong support
system and continued reiteration of her desires for her babies' plan of
care.

Warmly,

Jean

Jean Macomber, RN, IBCLC
Lactation Consultant
The Family Birth Place
St. Luke's Hospital
Jacksonville, Florida  32216
904-296-5212

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