DAY 6: Food
While they’re in the NICU, premature babies have several milestones to meet before they can go home with their parents. Before NICU discharge, premature babies need to be able to breathe, eat, and keep their temperatures stable.
Breathe without oxygen: One of the first milestones that many premature babies meet is being able to keep their oxygen saturation high without needing extra oxygen or other respiratory support. Many preemies need some kind of respiratory support soon after birth. Some babies may only need extra oxygen for a short time, but others need it for longer. Babies who are very small or very early at birth are at risk for a chronic condition called BPD and may need extra oxygen even after they’re ready to go home.
Luckily we did not need to be intubated, even though I did not get any steroid shots before BB#2 was born. BB#2 did not get any surfactants either after he was born. He was on CPAP for a few days and after that he got oxygen into his incubator for a few weeks. And finally he was breathing on his own without any help, any plus oxygen. He did not develope BPD.
Maintain a stable temperature: Most premature babies need to sleep in an incubator to stay warm. Premature babies aren’t able to keep themselves warm. It is a milestone that is based on weight more than gestational age, and most babies are able to keep themselves warm by the time they weigh about 4 pounds.
Take all feedings by mouth: Premature babies are not as strong as full-term babies and aren’t able to coordinate sucking and swallowing until about 32 to 34 weeks gestational age. Most premature babies are nourished with TPN (total parenteral nutrition, a type of IV fluid that provides total nutrition to someone who cannot take any nourishment by mouth. TPN contains sugars, electrolytes, vitamins, proteins, and fats, and can supply all of the nutrients that the body needs. Premature babies often receive TPN while their intestines mature. The TPN will be given through an IV, an umbilical catheter, or a PICC line. When milk feedings are started, the amount of TPN that a baby receives will gradually be tapered down as the milk feedings are increased.) at first, and they are fed through a feeding tube until they’re strong enough to drink from the breast or from a bottle. Before babies can be discharged from the NICU, they should be eating from a bottle well enough that they are gaining weight steadily.
BB#2 had the most problems with feedings. He had a feeding tube for about 6 weeks, through which he got my breast milk that I pumped for him around the clock. He also received parenteral nutrition through his PICC line for weeks. In the begining he had problems with digesting my milk. He would get sick from it. So there would be days he did not get any milk, just the TPN. It was the most awful feeling that I would take him the milk and they would say he cannot be fed through his tube yet 😦 We had to run at this feeding issue 3x times before he finally stopped getting sick and could start getting my milk, but this took about the first 10 days of his life. They also started to investigate if he has NEC (Necrotizing enterocolitis, where portions of the bowel undergo necrosis (tissue death)). They said the x-ray did not prove this, and finally he overcame the problems and started digesting the milk.
Eventually he learned to take a bottle, and a few days before his discharge he started learning the art of breastfeeding, which he continued to do untill he was 9 months old. My milk however was not enough so we had to supplement with formula and pumped milk, so our feeding routine was a pain in the…. First measure baby, then breastfeed, measure baby again, calculate how much he ate, then make some formula, feed to baby. Then pump the remaining milk that he left inside, because he was too tired to work that hard 😦
So as you can see feeding preemies are not easy. Not easy for the baby, or the Mom or the doctors/nurses.
And still we came out lucky because after the initial problems we did not develop reflux or any oral aversions and we were not even colicky
BB#2, 11 days old. You can see the feeding tube in his mouth and the TPN went into his arm. (not the one pictured, the other one).
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