Claudia,

Are these babies being "kept on TPN" exclusively, receiving no other
calories such as formula? And are they being kept on it longer than the
standard 24 to 48 hours prior to starting enteral feeds? Our neonatologists
usually start out allowing the babies to have one to two breastfeedings per
24 hours and if they tolerate these well will advance them accordingly. Some
will advance to full breastfeedings while in the NICU. Most will have some
combination of feeds at the breast and tube or bottle feedings (depending on
their situations). Many are able to have exclusively mother's milk and some
have some amounts of formula. Calorie needs are calculated by the
neonatologists every day based on weight and age and adjusted accordingly.
If a baby does well at the breast it can only help. We teach Moms to
recognize and respect baby's signals that their limit has been reached, such
as closing eyes, refusing to open mouth when nipple is offered, splaying
fingers on outstretched hand in the "stop" gesture, etc. I'm not saying it
happens perfectly every time, by any means, but this is the general process
in our level 2 NICU and is pretty much a standard in our area.

Hope this is what you were looking for.

Jean Macomber, RN, IBCLC
The Family Birth Place
St. Luke's Hospital
Jacksonville, Florida
> ----------
>
> Date:    Fri, 14 Sep 2001 21:24:46 EDT
> From:    [log in to unmask]
> Subject: TPN
>
> Our level 2 Nursery is getting the ok to keep babies on TPN.  I am
> wondering
> if there are any indications I should be aware of in regards to
> breastfeeding.  I have never worked with a baby on TPN to even give me an
> idea where to start.  Anyone with this
> experience that could help would really be appreciated.  Thanks!
>
> Claudia G RN/IBCLC
>
> ------------------------------
>
>
>

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