gayle omansky

Yes, we also have a nutrition kitchen where the milk refrigerators are and all the needed supplies for adding calories. I know there are differing opinions on handling the MCT oil. We mix 12+ hrs of feeding volume at a time to keep in the individual bins in our refrigerator. We shake before poring out the feeding volume. Some nurses will invert the feeding syringe if it is on a pump so that the oil goes in first. Another unit I worked in the oil was separately put down the feeding tube before the feeding. Does enough of the oil stick to bottles or tubes (we use silastic) to cause a problem? Enough of a problem to syringe it into the baby's mouth? The "proof" would be the baby's growth curve. Is there that much of a difference between the growth curves of babies with the oil mixed in or syringed into the mouth?

Hi Batkin, Our protocol has one additive until we reach 24 calories/ 30ml. After 24 cals we use a second additive which is medium chain triglycerides. We also use an additional protein additive and occasionally a carbohydrate additive. Our recipes have been created by our pediatric nutritionist in consultation with our referral institution and the product manufacturers, most of the time we max at 28 cals/ 30ml, but occasionally we have gone to 30 & 32 cals/ 30ml. We make up the added cal feedings ahead of time (12-24 hrs.). I have also worked in a unit where the medium chain triglycerides were added at the last minute.

OK, something is going wrong with my link address. I have tried editing it with no luck. Anyways, it is eneonatal review sponsored by Hopkins. G.

Hi Thabit, I came across an archived issue of eneonatal review which is put out by Johns Hopkins that I thought you would be interested in. They have an issue or article devoted to family centered care in the Nov. 2008 issue. The link: www.hopkinscme.net/ofp/eneonatalreview/newsletters.html Take care, Gayle

Hi Susan! We do not have experience using the safety pins, but if they turn out to be a problem consider using the cap with the velco strap & foam holders by INCA/ Ackrad Labs. Both hospitals I have worked in have used this product with good success. Regards, Gayle

Hello! We also do not use any sedation for MRI or CT scan, we also make sure they are fed shortly before the procedure and we do not have to repeat imaging. We swaddle and use a pacifier and have success. The papoose bag does sound interesting though! Regards, Gayle

Thank you everyone for taking the time to answer this question. It is reassuring that our practice is in line. Particular thanks for the citation - we will get this article. Gayle

When we use Ampicillin & Gentamicin for intravenous therapy it has been our habit to dose with the Ampicillin first because it is readily available in the unit, then start the Gentamicin dose second. The discussion at the moment is whether the Gentamicin should be first and how much of a wait between the two medications. Would you all share your thoughts. Thanks, Gayle

Hi Thabit, You can get many articles on parenting in the NICU from the Academy of Neonatal Nursing & their journal Neonatal Network (one of the sponsors here). For a short answer though I agree that holding as soon as possible is key for parents. Most would be in favor of skin-to-skin holding. I am wondering if privacy is a concern for your unit. If you can facilitate skin-to-skin on your unit I think you will have happier parents. I agree with both above that encouraging to participate as much as possible helps them to feel that this is their babe, not the unit's babe. I should have a recent article on family-friendly units at work. You can contact me at gayleomansky@hotmail.com if you would like it.

Hi Amira, We use fresh mother's breast milk (MBM) if at all possible. We will keep plain MBM refrigerated for 3-4 days prior to use, but if we have added Human Milk Fortifier to the milk we must use it up within 24hrs. We use plastic containers for MBM storage & I know there has been discussion in the past re: glass or plastic. We use plain MBM for feedings until the babe has reached feeding volumes of 140ml/kg/day. At that point we start adding HMF if under 35wk gest., or a preterm powdered formula for added cals if over 35wks. We move up as the babe tolerates feedings from 22cal/oz to 28cals/oz. We rarely go as high as 30cal/oz. Our unit has a pediatric nutritionist who weekly calculates the daily protein/kg intake of each babe amongst other calculations. I know there is some new research supporting increasing protein intake even more. I could get you a reference when I go to work tomorrow. Is this the sort of info you were looking for? As far as other info... some places use nutrition techs to mix feedings, but at my place it is an RN responsibility. Each babe has a lidded storage box in the fridge. Each container has a sticky label with name, ID # and birthdate. When we add cals we add another label which has all the possible additives specified & the RN fills in the amounts added. Hope this was the type of info you were looking for.

We use a silicone indwelling tube that the manufacturer states can be left for 30 days. That seemed too long so we leave in a max of 14 days. We secure to the cheek using a protective barrier under the tape or a breatheable membrane type dressing. If we a pumping feedings over time we use an enteral only type connecting tubing to avoid the mix up Jack (above) referenced. We also mostly do bolus feedings. We verify placement by pulling back for aspirate or listening for an air bubble over the stomach prior to each feeding. The infants sometimes do pull the tubes out but this is still less traumatic than the constant placement for each feeding.