Fw: prem care

[P & A Koziol]

Dear Jan I have some info  which may help to fill in the big picture so that you and your client can work through this problem. Most SCN will give parents the info not to expect to be able to take their babe home until his feeding reflexes are fully developed, and that this may take up until his 'due date'. However if this babe is now 35 weeks he may well be developing his feeding reflexes- some babes born at 35 weeks thrive from birth According to current feeding regimes his "quota" will be either 46 or 56 mls every 3 hours. He will be offered this amount at 3 hourly intervals not because it is when he is ready for a feed but because it is in accordance with feeding regimes suitable for most infants at this stage. Some will wake for feeds but many will not and will only take a small feed which may or may not be enough to sustain healthy development. If he is alert enough to take the breast for at least 10 minutes and milk transfer is audible during feeding why are staff gavaging pc the bf? Perhaps offer this milk via spoon or cup to appetite ie till the babe goes to sleep Consider offering all feeds other than bf via cup or spoon- sure it may take a little longer but will not cause nipple confusion in a small preterm infant who is just starting to learn how to suckle. Nipple confusion is never predictable but it is easier to prevent by not offering alternative nipples. This will also establish whether or not this infant is going to become exhausted with self feeding- if he is able to stay awake long enough to take his 'quota' he is probably ready to bf all day every day in his own home. Is it possible for the mother to feed more than once per day? If the babe is able to take 3-4 breast feeds in a row without tiring he can probably manage bf all day, again in his own home. Nursery staff will have concerns over continued health and development and unfortunately this can only be 'measured' by weight gains but needs to be considered in line with feeding performances and other indicators of wellness eg sleeping/wakefulness patterns. Are there any staff who will listen to a feeding plan that you could develop together (mother/midwife/scn staff) which could be tried for a day or two, measured and then an agreement to send babe home?   Hope this helps your client   Alesa   Alesa Koziol Clinical Midwifery Educator Melbourne