METHOD OF FEEDING/ PROVIDING NUTRITION

METHOD OF FEEDING/ PROVIDING NUTRITION

Broad guidelines for fluids and nutrition of LBW infants are discussed above.

Many LBW infants, especially those weighing > 1800 g, are strong enough to suckle well from the breast. This should be encouraged. However, care should be exercised to safeguard against distention of abdomen. This is best achieved though small feeds at frequent intervals. Breastfeeding should be considered as the preferred choice enteral feeding for all LBW babies. When it is not workable for some reason, gavage feeding(tube feeding) should be the choice, employing mother’s own expressed milk. There is sufficient evidence that necrotizing enterocolitis is far less in LBW infants fed mother’s milk than those on artificial feed. Further , LBW infants on own mother’s milk are known to grow faster than those on another woman’s milk.

Alternative method of milk feeding

Gavage (Tube) feeding

It is needed in:

1. LBW infants weighing < 1200 g or  <  30 weeks gestation after initial stabilization with IV fluids.
2. LBW infants weighing 1200-1800 g or <34 weeks gestation

Other indications of tube feeding are:

1. Baby getting tired quickly
2. Baby taking > 20 min to finish the feed.

For LBW infants, recommended size of the tube is No. 6 FG(French gauge) and No 4 FG in case of complicating respiratory difficulty. On an average about 16-17 cm of tube is needed to reach the stomach fro the gum margin. In a given situation, the tube is No. 6 FG (French gauge) and No 4 FG in case of complicating respiratory difficulty. On an average about 16-17 cm of tube is needed to reach the stomach from the um margin. In a given situation, the tube may be measured from the tip of the nose to the ear lobe and further to the ansiform cartilage. The measurement should be marked of the tube per se. In case tube feeding is required for a short period, it may be passed through the mouth. For this purpose, the wet tube is placed along the side of the tongue and then into the pharynx. The head-end of the baby needs to be raised.

If tube feeding is needed for several days, it should be passed through the nasal route into the esophagus and stomach. It should be kept in place. On the tube has been passed-irrespective of the route – its position should be conformed. To do this, gentle aspiration is required. The gastric fluid is usually colorless and acidic in reaction. If aspiration is difficult, some air may be injected and its entry into the stomach verified by auscultating the epigastric region.

Intermittent feeding: The outer end of the tube is attached to a syringe (20 ml) containing milk. It is important to bear in mind that milk should not be pushed, if safety is needed. Instead it should be allowed to trickle by gravity. The time taken by each feed nearly varies from 10 to 20 minutes, depending upon the size of the feed. This is about the time taken by an ordinary feed as well.

At the end of the feed, a few ml of plain water should be pushed to rinse the tube. If the tube is to be removed, it should be pinched so that no fluid trickles into the trachea as the end reaches past the larynx.

Continuous feeding (Intragastic Drip): Continuous milk drip has now won pride of the place in the feeding of LEW babies. Its advantages are many. E.g.:

1. Allow high milk intake
2. Weight gain is more
3. Less risk of regurgitation
4. Less risk of aspiration into the lungs.
5. Less risk of hypoglycemia
6. Nursing time is cut
7. Minimal handling of the infant

The technique of introduction of the tube into the stomach is same as in case of intermittent feeding. The outer end of tube is, however attached to the intravenous set containing milk. As intermittent feeding, infants head should remain slightly raised. His position should be supine. The tube should be changed every third day. It should be aspirated thrice daily. The bottle requires to be changed every 12 hours and the giving set every 24 hours.

Spoon feeding

The fact that even LEW neonates of 30-32 weeks gestation are good at swallowing even though their sucking may not be up to the mark forms the guiding principle of feeding by spoon. The tapering snout is placed at the angle of mouth. Then the milk is allowed to trickle slowly. The infant manages to swallow it without sucking. Repeat until the required quantity has been fed. It is good to be slow and patient, to avoid spilling of the feed. And also spoon is filled with milk and placed over the lips at the corner of mouth. Milk starts flowing into the mouth while the infant actively swallow it. Repeat the process until the calculated quantity has been fed. Avoid spillage. It is possible to find the quantity that has been spilled by wighing the napkin around baby’s neck before and after the feeding.