AngelaCondie

Thanks for the video on LISA. That will change my technique- WOW! Blessings, Angela Bach Christian Hospital, Qalandarabad, Pakistan

In preemies, do you start calcium in the IV right away? How much? Do you have a problem with calcium infiltration of the skin? We have used D10 for the first day, then switch to D1/5. If they are still not tolerating feeds by the third day, we add KCl. When should we add calcium? Should we use D1/2 instead? Thanks

We usually start 2-3 cc/kg/feed every 3 hours with EBM or preterm formula if the baby is well. We don't have banked milk. If there are aspirates after the second day, then we begin to replace the aspirate, subtracting it from the total amount of milk scheduled to be given. (For example, if the aspirate is 2 cc and the scheduled amount is 5 cc, we give the 2cc aspirate back plus 3cc of EBM.) This way, we can see if they can tolerate the feeds. If the aspirate is large, then we hold the feed until the next scheduled time. We don't have HMF, so we use preterm formula to fortify the EBM. When they seem able to suck, we start breast feeding three times a day. When a baby is on 30cc/feed, then we add 1/3 scoop of dry preterm formula to the feed to increase the calories to 24/ounce. As they are able to tolerate breastfeeding, we change from NG feeds to cup and spoon. We discourage bottle feeding because of the hygienic conditions in the villages. As the baby gets stronger in breastfeeding and taking the cup and spoon, we gradually decrease the amount of extra feeds, so that he only gets breastfeeding by the time he goes home at 1800gm. If you have any comments on this, I would really appreciate any feedback or suggestions. We don't have ventilators or central lines. We have amino acid solution that we use to supplement feeds in the early days.