Nutrition - IV Therapy
On admission to the NICU, many babies are too small or too sick to eat by bottle, or to breast-feed. If this is the case, intravenous fluids will be started. IV's are small catheters inserted into the baby's veins, to allow fluids and medications to be given directly into the baby's bloodstream. You may be asked to leave the unit during the insertion of any type of IV. This is to allow the staff to concentrate on your baby and the task at hand, and not on your reaction to the task. This will usually mean that the IV will be started quicker, and with less discomfort for your baby. Once the IV is in place, you may return to your baby's bedside. There are 3 ways for IV fluid to be administered to the baby:
Umbilical Artery Catheter (UAC) or Umbilical Vein Catheter (UVC)
Feedings, once started, are an important part of your baby's growth and development. The decision to breast feed or bottle feed is an individual decision for each mother to make. When feedings are started, they are usually started with small amounts of milk/formula, and supplemented with IV fluids. As the amount your baby eats increases, the IV rate will decrease. Eventually your baby will be taking enough milk/formula to no longer need the IV. Babies can be fed several ways and your baby will be assessed to determine which type is appropriate.
Babies that are older gestationally (closer to their due date) can often be fed by bottle or can breastfeed. Sometimes babies that are smaller or sicker cannot be fed by bottle, and need to be fed by tube. This small plastic tube is placed through the nose or mouth and ends down in the baby's stomach. The milk/formula is slowly allowed to trickle down the tube into your baby's stomach. There is a brief period of discomfort when the gavage tube is first inserted, but then the tube can be left in place for up to seven days, then changed. (Unless the tube becomes dislodged or pulled out, then it will be reinserted sooner) Once this tube is in place, the baby doesn't even feel the milk/formula entering his stomach. Often the nurses will give your baby the pacifier while he is being gavage fed. This will help to strengthen his suck and to help soothe him. As your baby gets older/bigger, the baby may begin to attempt bottle feedings. Premature babies are usually ready to try bottling by 32-34 weeks. Before this time, your baby may have a strong healthy suck, but may not be able to coordinate this with breathing and swallowing. The nurses will assist you in bottling/breast feeding your baby during this time of transition.
Congratulations on your choice of breastfeeding as the source of nutrition for your baby! The following information is presented to help your nursing experience be a successful one.
Breastmilk is natural and easier to digest for most babies than cow's milk or soy formulas. Your breast milk changes and increases in volume as your baby grows. The first milk your body produces is called colostrum. The content of fats and proteins found in colostrum is different from that found in the milk your body will produce in a few days. There may be a long wait before your baby is ready to nurse directly from your breasts, so you will need to use a breast pump until then.
The keys to making milk are: good nutrition, rest, and breast stimulation. Remember, you now need enough food for yourself and milk production. Variety is key. Try to include the following: Four cups low fat milk, yogurt, cheese. Five or more servings of fruit , juice, or vegetables. Six to eight ounces of meat, fish, eggs, or other protein sources like dry peas or beans. Six to eight servings of bread or grains. Also keep in mind that fluid intake is crucial. Try to drink six to eight 8-ounce glasses of water, milk, and juices. Limit your intake of beverages with caffeine (coffee, tea, soda) because it can cause irritability in your baby.
Having a baby in NICU can be particularly stressful, but good rest is essential to breast milk production. Napping can be refreshing and invigorating. Perhaps family, friends, or neighbors can help with your usual chores.
As breastfeeding is a "supply and demand" process, it is important that you begin pumping as soon as possible after delivery. Try to pump at least eight to ten times per day- every 2-3 hours while awake and once during the night. You should double pump every 2-3 hours for 15 minutes. There are 2 rooms in CCN (continuing care nursery) which you may use for pumping while visiting your baby or you can pump at your baby’s bedside. Your baby's nurse can provide you with a breast pump setup which you can keep at your baby's bedside. You'll also need to maintain this pumping schedule at home.
Because your need to pump is likely to be long term, it is important to use a hospital grade pump for best results. These pumps are available through our Lactation Services as rentals. They also have a variety of pumps available for purchase and can recommend the best method of collection for you and your baby. You will be pumping into plastic containers which will need to be labeled with your name, the date, and time you pumped. You can put all of the milk from a single pumping into the same container, but don't add new milk to the previous collection. You can bring fresh milk directly to the NICU after pumping. Fresh milk may be refrigerated for up to 48 hours. If it will not be needed within 24 hours, the milk should be labeled and stored in the freezer. Thawed milk needs to be used within 24 hours. We have some storage space for frozen milk in NICU and CCN but you will be storing at home as well. In a single door refrigerator with freezer inside frozen milk is good for two weeks; refrigerator with separate freezer for three months; and deep freezer for one year.
Even long before your baby is ready to go to breast you can do Kangaroo Care with your infant. Also known as Kangaroo Maternal (Mother) Care or Skin-to-Skin Contact and Breastfeeding, this is a method used to restore the unique mother-infant bond following the sudden separation during the birth experience particularly in premature births. It consists of skin-to-skin contact, exclusive breastfeeding and support for the mother-infant pair. This skin-to-skin contact can improve your milk supply as well as promote bonding between you and your infant. For more information on kangaroo care, talk to your baby's nurse. Infants develop the ability to coordinate suck-swallow-breathe techniques required to eat by mouth around 32-34 week's gestation. After kangaroo care, you may be allowed to put your baby to breast to nuzzle one to two times a day. As your baby develops further, you'll be allowed to attempt nursing and the frequency of this will increase until, ultimately, you're nursing for all feeds. In NICU and CCN we can provide you with screens for privacy, comfortable chairs, footstools, and pillows for positioning. Your baby's nurses are specially trained to assist you with various positions such as cross-chest and football holds and other techniques for successful nursing. The nursing staff of the NICU/CCN can address most issues/problems with breastfeeding. At times, however, concerns may arise which pose a challenge to our staff and in these instances we can call in our Lactation Consultant. Baystate Children's Hospital also offers various support services for families once their babies are discharged.