>Nancy said,
>
><< And, if it is breastmilk, at least the aspiration isn't as likely to be as
> much of a problem as if it were formula." Please give me a reference
I know it's in R. Lawrence's book, but she probably cited a primary source.
>
>In the 17 years I've been working at this hospital, we've never had a
>problem, and my guess is that 95% of the boys delivered here are circumcised.
> And there has never been an NPO policy in the 17 years I've worked here, for
>either breast or bottle fed infants.
That is why I asked if we have any research data on it. A prospective study
would never make it past the IRB. But what about a retrospective study?
Let's see....17 years x 1000 (or whatever) circumcised boys per year, all
discharged from the hospital alive and well.....with such a huge sample I
think it would be hard to ignore the findings. I'm not a fan of using our
casual observations, and heaven knows I'm not a researcher, but it seems to
me that we are basing our NPO practice on *nothing* at the present time.
Seems like a simple retrospective study with a huge sample would be better
than our fears and presumptions and "what if" notions that are instead
guiding practice.
>
>Perhaps my real question is: are we keeping babies NPO for circumcisions --
>and moms NPO in labor because we have good, solid, evidence based research
>that this is BEST for the majority of humans, or because of a theoretical
>possibility that something may happen -- tradition based medicine?
We *do* have good, solid data that holding mothers NPO in labor is
detrimental. THe medical community continues to ingnore this entire body of
literature which dates back to at least the early 1980s, with some "looser"
studies in the early part of the century. Don't get me wound up on this;
it's one of the reasons I can't bring myself to work L&D any more.
It's tradition! Not evidence! We have generalized studies from adults to
newborns. That is, of course, ridiculous, because we certainly wouldn't
generalize data like that for other situations. For example, who would say,
we need to use a 22-gauge, 1-1/2 inch need to give an injection to a
newborn because that's what we use for an adult? No one. Of course not.
Kids don't have the same hematocrit as adults, or the same blood pressure
or anything else. And certainly we *know* that their early gag reflex is
not like adults.
>
>And since formula takes longer than breastmilk to be digested, and the baby
>(in the first couple of days) who is being formula fed, generally gets more
>formula than the breastfed infant, shouldn't we keep that baby NPO longer
>than a breastfed infant if we are concerned about potential aspiration during
>the circ?
Maybe a comparative study *would* get by the IRB.
By the way, did this NPO practice start around the time that formula became
widely use???? Hmmmmm. now that would be interesting! If so, then we are
generalizing "findings" (if there are indeed findings) from formula to
breast milk. Oh dear...same old, same old....
>
>I'd really like to know. Do we have ANY literature, supporting one notion or
>the other?
Do we have any researchers in this crowd?
>
>Jan Barger, RN, MA, IBCLC
>Wheaton, IL
>
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Marie Biancuzzo, Perinatal Clinical Nurse Specialist
PO Box 387
Herndon VA 20172
Phone 703-748-0092
Fax 703-758-0891
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