M.M. asks from Saint Petersburg, FL on August 12, 2011
NICU Rant/question - Corrin Update
Corrin is doing much better. He's been 100% off of oxygen for the last 48 hours, they realized part of his irritability was having the nasal cannula which also ended up unnecessary. They also realized they were making his environment too hot, so they allowed him to cool off - both these things plus allowing Mommy and Daddy to hold him as much as possible has helped his rapid breathing slow down and calm his temperament.
Now comes the rant. A 5 day old infant's stomach cannot hold more than 50ml (2 ounces)... not even a TWO WEEK old stomach is meant to hold more than 2 ounces a feeding. They started to give him 45-50 ml's every 3 hours - fine. Then they started upping EACH feeding 5mls until they reach 80mls per feeding. What in the hell are they trying to do? My son is barely a pound over the normal range of weight, yet they are feeding him like a 3 month old. I am very upset and feel it is setting him up for staying in the hospital LONGER because he cannot and does not want all this food which they are pushing on him and he refuses to eat that much by bottle... which means they force feed it thru his nasal gastric tube.
His breathing is SO CLOSE to the average range, his weight is lower and is stable now (went from 10.8 to 10.3 which is very acceptable), he is awake and happy now - I know there are many Moms who've had infants in the NICU and may even be some NICU Nurses here - so here comes the question:
I am having a discussion with his Neonatologist tomorrow about how I disagree with the feeding issue. How much clout does the infant's parent have in changing the orders and schedules set and can I demand a second opinion from another hospital while my child is at the original one?
So What Happened?™
Picture of Corrin is on the profile pic.
D.P. answers from Pittsburgh on August 13, 2011
He is a CUTIE! All that hair!
OK-I think you have every right to discuss any concerns with the neonatologist that you have. But remember that this IS a NICU. These people are not pikers when it comes to babies. Does that mean you should blindly follow any & all advice? No. Speak up! But you gotta give credit where credit is due, right?
Listen to any & all facts and get facts & opinions from the docs.
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K.J. answers from Chicago on August 12, 2011
I have had 2 babies in the NICU, and both were able to eat at LEAST 3 oz (90mL) within a week of birth. You have to realize that these NICU nurses and neonatologists do this EVERY DAY and take amazing care of some VERY sick kids. I trust the NICU teams we have had more than just about any other health care professional I have ever encountered.
You can disagree, but what is your basis? Do you have research to show that your opinion about it is correct?
(my 2nd son drank a 2 oz bottle within 45 minutes of birth--NOT exaggerating at all).
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S.B. answers from Redding on August 12, 2011
I know you are going through a rough time, but I'm not sure what you are upset about.
Newborns can eat 2-3 ounces, per feeding, at least 6 times per day. That's every 4 hours. Some newborns eat every 2 hours.
You say he is awake and happy.
I mentioned in my last response that my little grandson was born with a lung infection and had to stay in the hospital. It was very scary, but his doctors and nurses knew what they were doing.
Having worked in the OB ward at a hospital and seeing the level of care that babies receive, I think you should talk to the neonatologist, but also be willing to listen.
My daughter was so distraught about not being able to take her baby home (from a different hospital than I worked at) because he was SO CLOSE for days, but in reality, close doesn't cut it when they are releasing a baby.
My grandson was finally released and has had NO health issues whatsoever. He had a rocky start, but he was tended to according to what his care required.
I don't know that you can "change" a physician's orders.
You can refuse care for your child against medical advice.
You'll be having a meeting with Child Protective Services before that happens and I say that because I've seen it happen.
As far as getting a second opinion, you can demand it. Chances are that the pediatricians at the hospital have already conferred.
If you believe your child is being harmed in the hospital, for being fed, you need to be able to back that up.
I am NOT trying to be mean or lessen your concerns at all. I promise.
I went through this with my own grandson in May and my daughter, God bless her, did not handle her baby having problems very well.
It was traumatizing for her.
She hated the I.V.'s because they hurt him, she hated the oxygen, she hated him crying because they poked and checked on him all the time. She hated the nurses for not leaving her baby alone.
HE survived the whole thing just fine and is the most beautiful and healthy baby you ever saw.
His medical team knew what they were doing.
They did it swiftly and they were diligent.
He's healthy now because of it.
I think that you need to write down all of your concerns. You have a right to them. You really do.
Get them off your chest. Try to get some rest.
Also be open to the possibility that no doctor or NICU nurse on the planet wants to do anything to your baby that isn't necessary.
That's just my opinion.
I wouldn't wish this on anyone especially after going through it with my own daughter and grandson.
There is light at the other end.
Your baby is progressing.
That's a GREAT thing!
9 moms found this helpful
R.H. answers from Boston on August 13, 2011
Before you ask for the orders to be changed ask for a family meeting and ask them to explain how they determine goal rates for feedings. Also ask any other questions you may have. That's the easy part. The hard part is to then LISTEN TO THE ANSWERS with an open mind. You might be surprised to hear that their explanation makes perfect sense, and they are, in fact doing everything they can to help your child recover. HOpefully that is the case.
When nurses advance a person's feed rate they often check a "gastric residual," which is when they draw back on the feeding tube to see if there is any left over liquid in the stomach. If the person has a lot of residual liquid in the stomach then obviously they are not absorbing, and they can not tolerate any more tube feeds at that time. The tube feeds will be put on hold until the gastric residual is below a certain # of cc's. On the other hand, if the tube feeding is absorbed well, and there is no gastric residual (or its' a small amount) then it is safe to resume tube feedings. Of course they also monitor stool output, bowel sounds, abdominal distention, firmness of the abdomen, etc. If any of these assessments were out of the ordinary they would not keep giving feedings. I'm not a pedi nurse but I assume the GI assessment for adults and kids is similar.
9 moms found this helpful
R.C. answers from Phoenix on August 13, 2011
Thank you so much for the update on your son, Corrin. I'm thrilled to hear that he is doing so well! Although I'm a Nurse Midwife, I worked L & D, Postpartum and NICU many years ago when I was an RN working my way through grad school. A good rule of thumb for maintaining body weight in a newborn is that the baby needs 2.5 oz of formula or breastmilk per day for every 1 pound of body weight. So based on his birth weight of 10 lbs 13 oz, he would need between 27 and 28 oz per day (810 mL to 840 ml per day) There are 30 mL per fluid oz so 80 ml is really just over 2 1/2 oz and is very reasonable and conservative estimate of his needs. Your son needs to take in more formula/ breastmilk than the average newborn to maintain his body weight. Please ask your nurses and Drs. to explain things to you. It's overwhelming to you I'm sure, but I never felt threatened or annoyed when a parent genuinely had a question about the care of their baby. Best wishes for a happy homecoming soon.
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L.U. answers from Seattle on August 12, 2011
Mama - The NICU is where I learned to be a parent. My son and I stayed at Children's hospital here in Seattle for almost 2 months. I also had a boy on an NG tube. He was 3 weeks old. I don't remember how much he was being fed, but I remember thinking that I didn't agree with what they were doing and had to speak up and ask!
YOu must must must talk to them. Talk to the doctors, talk to the nurses, talk to your child's pediatrician. There is nothing wrong with asking questions and there is NOTHING wrong with not agreeing with them. Bring to them any statistics you may feel are important and ask questions.
Remember also, these doctors are not here to make your child stay in the hospital longer than he needs to. They really and truly love their jobs and want children to be sent home as soon as they medically can be. They want you to be a family unit AT HOME just as much as you want to be at home.
Good Luck to you and your baby.
8 moms found this helpful
L.F. answers from San Francisco on August 12, 2011
I am sorry you are upset with the feeding issue. I think you should remember that neonatologists and NICU nurses do this day in and day out. They have the same goal as you--to get your son home asap and as healthy as he can be so he can go home. Please get some support from your family and friends and allow the doctors and nurses to do their job. They won't overfeed him. They go through 10+ years of medical school and training to get to where they are. I think your being upset and your feelings are misplaced. Try to breathe and if it makes you feel better, get a second opinion. Best wishes and I hope that Corrin comes home soon!
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R.J. answers from Seattle on August 14, 2011
Well... couple points: (Please, do read down to #3, even though 1&2 may tick you off)
1) My 3 week old son was drinking apx 20oz (TWENTY, yes, not a typo) PER feeding every 2-3 hours. (We were part of a breastfeeding study). He was 10lbs at birth and 12 or 13 by week 3. Some full term newborn infants can only manage an ounce or 2, most can do between 3 & 8. A couple ounces is the bare MIN. So when you start off on the basis that in order to live/ not be 'failure to thrive' you need at least that much (80ml) and can go up to 10-20oz per feeding... that's a "Relax..." set of numbers... not necessarily a 3mo feeding schedule. 60-80ml is a preemie bare minimum goal (4-5lbs). A healthy 10lb newborn usually goes for over 200ml.
2) NICU babies -even full term- tend not to eat well for a couple reasons. A: they're stressed out, and the increased adrenaline, just like in adults, shuts down the hunger response. Well... they still need the nutrients to be healthy. Unlike with an (most) adult patients, with NICU & PICU patients you can't tell them "I know you're not hungry, but you need to eat anyway." Instead you NG them, and work toward getting them eating the bare minimum even under the huge amount of stress they're under. B: Babies tend to be in the NICU for a reason that makes them tired. They're using every bit of available energy to heal/recover and the physical act of sucking and swallowing is just too much. So even if they ARE hungry, they turn and refuse to eat more because they're just too tired.
3) As to how much sway a parent has... QUITE a lot, to a certain point. You're there 24/7, and most good NICUs consider (and even title) parents as "Parent Caregivers". Parents tend to notice things first, and hold onto all the little bits of info from the course of the day in their minds, only have 1 patient, and aren't taking notes from a previous shift. MOST NICUs consider you part of the team with a full 'vote' in your child's care. There is, however, a VERY steep learning curve... and a lot of sleep dep. The line at which parents are disregarded is in 2 places: a) when it will cause the child harm without question and b) when they are completely and totally distraught/furious/losing it. If you're completely emotional, staff assumes (mostly correctly) that you're not thinking clearly and at the VERY least need a break, a sleep, or an eat... and most will flat out refuse to listen to a word you say until you're able to calm down and present your thoughts clearly. Even if that's just an "I can't think right now, can I have a little bit of time to process, and we can revisit this in a few hours?"
4) 2nd opinions are common. If you're not at the regional children's hospital, grab your 2nd opinion from THEM. If you are, then you've got the hands down best staff available in 3 states... so jump departments.
Hugs!!! Handsome little guy!
7 moms found this helpful
C.O. answers from Washington DC on August 13, 2011
My boys were in the NICU - i was pumping so they gave my boys what I pumped and they only supplemented them with formula when they told me to sleep the night through instead of coming back every 4 hours....it was hard to stay away - but the best thing I did because I got sleep...
Instead of going in like a bull in a china closet - go with NICELY with questions...it's OKAY to ask questions...you might learn something about WHY they are doing what they are doing when you ASK rather than go in hell bent for leather....remember honey, not vinegar...
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