Dawn,
It has been a few years since I worked in a level 3 NICU in Temple, Texas, but I do know on the VLBW or very low birth weight babies, they usually start the IV fluid using the Glucose water you describe then changing to hyperalimentation with lipids at about 3 days. The baby's gut is unable to start digestion of anything (except the small amount of bile) even mother's milk because of the babies fight for life, at this age. Then after a period of what seems to be 2-3 weeks or about 27 weeks gestation they begin 1/2 strength feedings of 1.5-2 cc of sterile water mixed with mother's milk through a feeding tube. The baby is usually fed every 3 hours this way, checking for residual (leftover undigested milk in the stomach) before each feed. If the baby is not having residual, then they increase the feeds slowly of the 1/2 strength human milk until the baby is able to take 5-7cc. Then they go to full strength human milk. All of this progression is timed to the baby's response and not
just done on a timeline. The baby will usually be tube fed until he/she displays a gag reflex (at about 32-34 weeks gestation-a natural reflex that's a protective mechanism to prevent aspiration of the fluid into the lungs instead of the stomach) and then be allowed to nipple feed at mom's breast, although we all know the baby can spend time at mom's breast (best after pumping) way before all of this gag reflex becomes present.
I try to explain to mom's that human milk is a physiological fluid and how beneficial it is to start the babies off right. And that their milk would never harm their baby, but help to make the baby healthier, and it had to wait until the respiratory and circulatory systems got established before we begin the intestinal system. That pumping at this time is a valuable contribution and we would store the milk in our designated freezer. Then I would explain the mechanisms for digestion and why we would have to wait to start feeds until the respiratory system and vascular system had been regulated.
Our neonatologists would ask every mom to pump for her baby whether she planned on breastfeeding or not and would explain the medical reasons (lower incidence of NEC etc.) Almost all of our moms would pump to start with.
It was such a nice thing to "bask in the light" of support for human milk at that NICU. I really loved it. We still had those people who tried to sabotage the value of human milk, but they were few and far between.
Theresa Johnson
now in Orlando Florida
"Dawn K. Martin" <[log in to unmask]> wrote:
Wise Ones,
I seldom see babies in this situation so I thought I'd ask those who know.............
Premature baby born at 25 weeks gestation. Hospital is giving glucose water via IV.
Is this typical? How soon might breastmilk feeds begin via gastric tube (or other route)? I know every situation is different with a baby this early, but ballpark, or signs to look for. Parents very much wanting to get breastmilk into baby, but this is WAY beyond what I usually deal with. They've contacted me as an acquaintance who can help them decipher what they're hearing at the hospital.
Many thanks,
Dawn Martin, CD (DONA), IBCLC
Austin, TX
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