C.B. asks from Spring, TX on April 26, 2008
Question Regarding Feedings in NICU
My niece was recently born at 34 1/2 weeks. She has been in the NICU for one week. My sister in law is pumping and taking the milk to the hospital. The hospital sticks to scheduled feedings which I personally have never done with my three children. I assume possibly things are different with a premature baby. My brother has witnessed them feeding her and then forcing the rest of the milk to her through the tube in her nose which she then spits up. They won't let them take the baby home until she stops spitting up. My sister in law is getting discouraged thinking it is her milk. I personally think if she was fed on demand, things would get a lot better. My mother has been there and she woke up crying and they would not let them feed her. Then when it was the scheduled time to eat, she didn't want to. I feel she is spitting up due to her little stomach not being able to handle all the milk they are giving her so quickly. I would love to hear any experiences because they are getting very discouraged at this point.
UPDATE: MY NIECE WENT HOME TODAY. I HAVE NOT GOTTEN ANY DETAILS OTHER THAN THAT. AGAIN, I APPRECIATE SO MUCH EVERYONES WORDS OF ENCOURAGEMENT. I HAVE LEARNED A LOT FROM THIS SITUATION THROUGH THIS WEBSITE AND FOR THAT I AM VERY APPRECIATIVE!
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So What Happened?™
I wanted to thank everyone so much for their responses. I was hoping to be educated on how things work with premature babies and your responses have been very helpful. I have told my brother that I don't know what to tell him because I imagine everything is different due to her being premature. I will share the responses with my brother and I am sure it will help reassure him that as hard as it is to watch, it is all in the best interest of the baby. The reason I posted this question was because my mother went to see the baby last night and they had to force the milk on her and then she spit up. She said my brother and sister in law just broke down in the waiting room because they don't understand it all and want her to come home so badly. Again, I think these responses will help them and I appreciate everyone taking the time to answer my question.
I am new to this site and don't know how to update things yet but I wanted to again thank all of you so much for taking the time to respond to my concerns. It means so much and it has helped me. I wasn't very detailed in my first request and wanted to let everyone know I have not said a thing to my brother or sister in law about my concerns. I would never do that unless I thought the baby was in danger. The reason I posted this request was for myself to get educated on the differences in premature babies and term babies. My hopes were that things you all said from experience would put my brothers mind at ease that everything was happening exactly the way it needed to. I told him already that I don't know what to tell him because I assume it is all different due to my niece being premature. To try to answer a few questions, she was born 5 lb 12 ounces. I really don't know how much they were feeding her - it was just hard for my brother to witness it. I am a firm believer that there is no way we can "guess" what someone is going through if we haven't gone through it ourselves. My heart truly goes out to all of you that have gone through having a baby in NICU because I don't know what that is like. I am so glad to hear all your positive results and I truly thank you all for taking the time to share it with me. I am really glad my friend recommended this site for me to ask my question because the responses and concern has been amazing. My brother did call me yesterday very ecstatic that they have taken my niece off of the scheduled feedings and are on a "to go home" schedule where they feed her on demand. The hardest part of all this was my brother and sister in law had such concerns with the way things were going but for some reason, they would not ask questions. I am just thrilled - she must be getting better and I am really lucky to have found this website.
S.B. answers from Houston on April 28, 2008
My last child was delivered at 32 weeks and spent 22 long days in the NICU. And I pumped my milk and took it to the hospital everyday as well, but he kept spitting up. Once we took him off the breast milk and put him on Soy he was fine. Today he is five and can have regular milk like all my other children. Good Luck with whatever you decide to do.
G.A. answers from San Antonio on April 28, 2008
C., I think you may be right about the feeding, but the hospital has to stick buy some sort of schedle SP. othe hospital would be a mad house..talk to the Dr. and see if the family was there why cant they feed there baby.just my thoughts. good luck with the little one.G.
T.W. answers from Houston on April 27, 2008
i am a nicu nurse. premature infants cannot be fed on demand. they do not have ability to store sugar for calories like term babies can. they must be fed on an every 3 hour schedule. it is a calorie "game" with them. i understand that it seems that she is being "forced" to take the other milk. she must receive sufficient volume with a sufficient number of calories in order to grow. spitting up/reflux is a very common problem in premature infants. that will not delay her discharge. she must, however, be taking all her feedings by mouth and gaining weight in order to go home.....which will more than likely be around 36-37 wks gestation/adjusted. 34 "weekers" are not suppose to be eating yet...they should still be in utero. your sister is doing the very best thing for her. her breast milk is the best food for her and the easiest to digest. the nicu "experience" is a process. it is difficult and frustrating at times. just encourage your sister and know that the people taking care of your neice are very knowledgable and trained in their very specific specialty. questioning and challenging them in front of your sister could cause her more stress than she is already enduring.
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B.C. answers from Austin on April 28, 2008
I am the mother of a six year old that was born at approx. 29 weeks and spent approx. 49 days in NICU before going home. My daughter was gavaged (sp?) which is the tube down the throat during some of the stay. With all due respect I would suggest that you not express your contradictory opinions to the new mother. Watching my child struggle and being on pins and needles every three hours when they would weigh her diaper to see if she had enough "output", or if she might have gained just 1/2 ounce in a day or two was enough stress without having more stress and doubts added by folks (well intentioned or not) questioning the NICU staff and doctors actions. NICU babies are fed on schedules in part because, like my daughter, most are born with no natural instinct to suck or eat, so when every day is so important to a premature baby's ability to thrive or not, it's important to "force feed" the infant even if 2/3 or more of it comes back just to keep the status quo for the life of the child. Also many premature babies have lots of intestinal/stomach issues which cause the "spit back". My daughter's intestines weren't fully developed (lining and such), so moving my breast milk through the intestines was difficult which caused a "back up" at the other end. By all means, however, if your sister-in-law is expressing doubts or questions, encourage her to speak with the NICU doctor. The fact is that your sister-in-law is doing the most wonderful thing she can by providing her breast milk b/c any NICU doctor will tell you that even in the fragile state most premature babies are, the use of breast milk (even donated from the milk bank), is so much easier on the baby and causes less "stress" to his or her little still developing system. There were many of days and nights I cried over being hooked to the "hospital grade" double pump wondering if it was even helping her, but when I saw how the other premature babies who were not using breast milk were having even more eating/intestinal troubles it made me resolve to stick with it. ;-)
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J.D. answers from San Antonio on April 28, 2008
My youngest spent a week in the NICU when she was a day and a half old. I had to breastfeed due to her relux problem. There was never a question on when the baby needed to eat or if they were feeding her. How often is your sister in law there wi/ the infant? if she was there and it was time to feed they wouldn't be able to tell her she couldn't feed her..i understand staying in shifts though. they kicked me out the first night saying i needed to keep my strength so i could take care of her when she came home to me. she couldn't handle formula, so i had no other choice but to breastfeed. i fed her when i was there and i pumped before i left. i pumped when i got home. i did all i could for her. Breast mix was the only way for her. We had a million test ran on her while she was there and left with an apnea monitor which she stayed attached to until she was 9 months old. i was so scared of losing my baby. but, i will say the NICU nurses were incredible with my little girl. My nephew however had a nurse that got too attached to him. he was born way early, and only weighed four pounds. My sister in law had to struggle to keep the baby with her when that nurse was around. She wouldn't allow Lindsey to do much with him when she was there. But in the end it all worked out. There may be some medical reason they are doing what they are. How much does the baby weigh? that could also have something to do with it..
C.B. answers from Beaumont on April 29, 2008
Well, I have experience on both ends. I am a mother of two who were both premature. One at 34wks and one at 35 1/2 wks. Both stayed in NICU for one week +. Plus i have worked in the newborn nursery/NICU as a nurse. Babies that are admitted to the NICU are all on feeding schedules until they are closer to be going home and then they are fed on a looser schedule that is closer to how mom and dad would feed them. That's not to say that a baby who gets hungry before his time to eat doesn't get fed, because that's not the case. Another thing is that the babies need a certain amount of calories per day in their feedings. The neonatologist will usually order like 10cc or 20cc every 3-4 hrs. If the babies don't tolerate that amt. they could run risk of losing weight and having a orogastric or nasogastric feeding tube placed until they are able to tolerate nipple feedings (where they are fed through a tube that's down the mouth or nose). There can also be intestinal reasons why babies do not tolerate their feedings but I would address these with the doctor. If the feedings are continually spit up or not tolerated by the baby, I would notify the doctor and ask them about it. I am not clear on why this baby would need OGT feedings at this time. The way we did it was if the baby went through quite a few feedings that were not tolerated or that were just not taken by the baby due to sucking issues or other medical issues like breathing problems. Every baby is different, and they can eat anywhere from 5cc to 45cc of milk. My 34 weeker started out eating only 3cc every 3-4 hrs. This amount per feeding is usually increased 5cc every few feedings or as tolerated. But do know that just about all babies do spit up to some degree, especially preemies because their little muscle at the top of the stomach that is for keeping food in, is not developed completely. You just have to know the difference between spitting up because they overeat and the pressure in their little bellies builds up before burping or the nurse if actually forcing them. And remember the nurse is doing as the doctor ordered, BUT it's also the nurses' resposibility to notify the doctor if the baby is not tolerating the amount of feeding that the doctor ordered. Hope this wasn't too confusing. Hope it all works out. Do reassure the mom that this is nothing to do with her. Breast milk is always better for baby (and mom as far as bonding goes) It is only a VERY VERY SLIM possibility that the baby could have allergies to her breast milk. The overfeeding issue should be ruled out before i would even begin to address a breast milk allergy ( which is much less likely than other complications). Best wishes to mom and baby!!
T.C. answers from San Antonio on April 29, 2008
I had a baby at 32 weeks and had to pump. My baby was fed the milk with droppers. You might ask the nurses why the droppers are not being used. Say a prayer as will I and the baby should be keeping his milk down better. It is not unusual for premies to spit up. My son did this the first two years of his life.
B.G. answers from Austin on April 29, 2008
I am a mom to a preemie born at 25 weeks and after 130 days in the NICU I have some experience :) From my experience I have found that the NICU and its nurses (the neonatalogists are part of the process too, but I'm referring to the more every day NICU experience) have one goal: to get the child home in a satisfactory condition for the child's pediatrician and other specialists. This satisfactory condition hinges largely on weight and calorie intake. As a mother yourself you are familiar with the growth curve and percentile measurements of weight and height that pediatricians follow so diligently each and every time your little one goes into the office. In a hospital setting the best way to guarantee such a condition is to feed on a schedule. My guess is that your niece is fed every three hours. Also many preemies are simply not in a condition to be able to only be fed on demand (if they are struggling to learn to breathe, maintain their own body temperature, etc). All in all, the thought process may initially seem harsh but the goal is weight and calories, weight and calories...all with the child's best interest in mind (I promise). With this in mind, the nurses, neos, and NICU in general are always trying to push the amount being fed a little more. For those little ones, like mine, who are learning to nipple (eat from a bottle) they get close to eating a whole bottle and then the amount per feeding is increased...what could be more frustrating?!
Has your niece's doctors or nurses discussed the possibility of GERD or more simply reflux? In such a little one the doctors cannot always perform the tests to definitively diagnose GERD, but there are other signs that may be enough to cause suspicion (baby arching their back, etc). The spitting up could be caused by reflux (GERD). In addition I assume that whether NG or OG (nasal or oral feeding tube) the additional milk is being processed through a pump of some kind. If so, then perhaps the remaining milk is going in too fast and your brother and sister-in-law can discuss slowing down the remaining milk. Delivering the calories needed is a struggle (even once they get home) and if your brother and sister-in-law are concerned that their daughter is being fed too much too soon, they should ask. I, by no means, am a confrontational person and I prefer to assume that the doctors and nurses are right and have my child's best interest in mind (which I'm sure they do), but I learned to be a little bit more questioning in the NICU. If in doubt, ask. Your brother and sister-in-law are paying good money (whether from their own pocket or through insurance, trust me, I know) for the care of their daughter, and NICU nurses and doctors are there to answer questions and make sure their plan is understood by the parents. Afterall, when these doctors send the little ones home, it is the parents that must be prepared to care for them.
I hope I've been helpful and concise. The NICU experience is an emotional one and no one can leave without having some very strong emotions and beliefs about said experience. Thank you for being a support to your family.
J.P. answers from Houston on April 28, 2008
I am a mother of a preemie baby and my son was in the NICU for three weeks before he was able to be released to come home. With my experience, a lot of preemies have reflex that will sometimes go away after time, and then sometimes they will send her home with a RX for help. My son was fed through the nose for the first week and a half and they they were giving him about 2 Tablespoons of milk at a time. They may have to feed your niece through the nose because she may not be able to handle nursing from the bottle yet. It takes much energy for little ones to suck from a bottle. My son was really healthy when he was born, but he did not have the instinct to nurse because they do not get this until they are about 36 weeks or so. Please tell your sister in law that they best thing that she can do for her daughter is to keep pumpng. They get much more from the mother's breast milk than they can get from formula. If your sister in law is stressing over this, it may also be more harder for her to produce the milk that she needs. They best advise that I can give the parents is to ask many, many questions on why they are doing things and the nursing staff will be glad to answer any questions to put the parents at ease. it is not easy having a newborn in the NICU and not at home.
I will the best of luck and things will get better as time goes on!
J.N. answers from Corpus Christi on April 28, 2008
Have your sister in law request to talk to the Speech-Language Pathologist and/or Occupational Therapist about the feeding schedule and amount to be fed. Also, she should talk to the pediatrician about her concerns!
J. - an SLP