Parenteral nutrition and other feeding support for babies in the neonatal unit

My name is Louise and I am a neonatal consultant.
For the babies that are in the neonatal unit
there’s a whole team of professionals that are involved.
Doctors, nurses, breastfeeding support,
pharmacists and we all work together as a team
and assess our babies throughout their journey
in the neonatal unit
and adjust the feeding support that they
need throughout their stay.
The doctors and nurses will assess the baby
and decide if they are able to have milk feeds.
But for those babies that have been born preterm
or perhaps are unwell with breathing problems
or problems with their bowels,
then they may not be able to have milk feeds initially.
In those circumstances we use a fluid called parental nutrition.
To give the parental nutrition we need
to put a drip or a line into one of the babies veins.
I’m Anisa, I’m one of the Clinical Pharmacists here in
the neonatal unit
and we’ll look at things like how much fluid they need.
Things like protein, carbohydrates.
All the things they would normally get from their milk.
And then we can review the results and their growth
to ensure that the nutrition that we’re giving them is appropriate.
My name is Matt.
This is our daughter Francesca
and this is my wife Louisa.
Francesca arrived prematurely,
when Louisa said she thought she was going into labour
and I just thought you can’t be,
you’re only at six months.
The midwife she started taking
all my vitals and said
‘yes, her heart rate is dipping’.
So obviously she’s in the distress.
Best thing to do is have an emergency C-section.
So it was a bit of a shock.
But they were all brilliant and they really put me at ease
and everyone explained it really well.
I think for me the biggest relief was hearing Francesca cry.
Francesca was born at 29 weeks.
I saw her briefly and she was perfect but then
she was taken away and when I saw her next
she was in an incubator
with all her wires on.
And that was really scary and it was sad
that I couldn’t hold her and I couldn’t feed her.
And I could only look at her.
Actually, it’s quite a worry seeing the wires
and the incubator but
I think that’s reassuring as well,
because it reassures you that if something does go wrong
It’s gonna get caught.
For our babies that have been born preterm they won’t
have developed their suck as yet,
so they’ll only need feeding support for as long as it takes for them
to be able to develop their suck.
We have a very standardised approach
to introducing milk to premature babies.
We like to get mums own milk,
which is full of all sorts of beneficial factors for babies
and things that protect against infection.
Things that help to mature baby’s gut
which is very important.
When the babies are well enough
we’ll start to give small amounts of milk.
That may only be one ml of milk every couple of hours
and that will usually go down a nasogastric tube.
So that’s the tube that’s in the babies nose
and down into the stomach.
We support parents in looking after their baby and educate them.
So part of that is training them
to do things like nasogastric tube feeding.
As soon as her feeds came up to a good point.
Straight away the nurse who was looking after her said
‘do you want to get trained on this and you can help?’
I said that would be amazing.
It was very technical and I thought there’s no way
I’m gonna be able to do this.
But it does, it comes quite natural and it was
quite a nice moment to have with Francesca.
I think the nurses that looked after her were amazing.
And they were so good.
Every time that I was in and I would do it,
they would just make sure that I was doing it correctly
and I felt comfortable enough to do it because that was important as well.
It’s amazing how
nervous you are because of the wires
and eventually I picked up the courage to say
‘Oh, I’m ready to have a go now as well’
but that was with Louise’s guidance
and a couple of nurses as well.
So Lucy is one of our premature babies
that we have in the unit just now
and dad’s just delivering
a feed through the nasogastric tube.
So before he starts the feed,
he does an aspirate
and tests the pH in her stomach.
Just to make sure that the tube is definitely still in the right place
and then he just attaches the purple syringe
and just slowly administers the feed.
I think Lucy gets two hourly feeds just now.
But before they go home, it will be three to four hourly ussually.
One of the things that we really strongly encourage
and it’s something we call kangaroo care.
Skin-to-skin contact.
It really helps to encourage maternal milk supply.
It’s incredibly important for mums and dads as well.
Being in the hospital it was easy enough
for me to come and see her and spend time with her.
But just knowing that I was going to be away from her was
quite daunting feeling really.
The only thing I could do for her was to feed her.
The team here we’re amazing
and they really helped me
with the breast feeding
and the expressing because it’s not easy
and it’s not easy when you’ve not got your baby close to you.
We do a lot to support mums to help
them provide their own breast milk.
We do acknowledge that that can be very difficult
even with the very best of help,
but we are very fortunate to have
the option of being able to provide donor breast milk.
In situations where mums, you know,
through no fault of their own,
are just not able to produce sufficient breast milk,
at least to start off with.
At first when they said she was ready to go home,
the first thing is you’re relieved and you’re excited
and can’t wait and then you think
oh no, hang on,
I’ve been looking at this machine to make sure that she’s okay.
What am I gonna do when there’s no machine there?
You need to just kind of realise that the doctor and nurses
wouldn’t let you go home if she wasn’t ready.
And you know that everything’s going to be okay.
She’s five months old and she’s brilliant.
I think we got home after just over seven weeks in hospital.
Getting her home was absolutely amazing
We had the long wait to get home,
but getting her back was great
and she’s she’s absolutely grand.
She’s like what you’d expect a new baby to be,
she feeds really well,
she cries really well,
she sometimes sleeps really well.
there’s no scars,
there’s no kind of impact of what she has been through.
There’s no physical signs or tangible signs.
She has benefited from being where she was.
And we’re grateful for everything that happened
and we wouldn’t change anything for the world.

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