A 32-week, 1400 g neonate is born to a primigravida. The baby did not require resuscitation and showed stable vitals. The baby was transferred to the NICU. How will you manage the feeding of the patient?
Correct Answer: Start total enteral feeding and IV feeding not required
Description: Ans. a. Start total enteral feeding and IV feeding not required (Ref: AIIMS NICU Protocol; Ghai 8/e p132-133)A 32-week, 1400 g neonate is born to a primigravida. The baby did not require resuscitation and showed stable vitals. The baby teas transferred to the NICU. For this patient, start total enteral feeding and IV feeding is not required.Enteral Feeding in Sick Premature or LBW InfantsThe optimal time to introduce enteral feeding to a sick premature or LBW infant is controversial.Trophic feeding is the practice of feeding very small amounts of enteral nourishment to VLBW preterm infants to stimulate development of the immature gastrointestinal tract.The benefits of trophic feeding include enhanced gut motility, improved growth, decreased need for parenteral nutrition, fewer episodes of sepsis, and shortened hospital stay.Once the infant is stable, small-volume feedings are given in addition to intravenous fluids/nutrition.Feeding is gradually advanced, and parenteral nutrition decreased.This approach may reduce the incidence of necrotizing enterocolitis.The main principle in feeding premature infants is to proceed cautiously and gradually.Careful early feeding of breast milk of formula tends to reduce the risk of hypoglycemia, dehydration, and hyperbilirubinemia without the additional risk of aspiration, provided that there is no indication for withholding oral feedings, such as the presence of respiratory distress or other disorders.If an infant is well, is making sucking movements, and is in no distress, oral feeding may be attempted, although most infants weighing < 1,500 g require tube feeding because they are unable to coordinate breathing, sucking, and swallowing.Intestinal tract readiness for feeding may be determined by active bowel sounds, passage of meconium, absence of abdominal distention, bilious gastric aspirates, and emesis.For infants < 1,000 g, the initial trophic feedings can be given at 10-20 mL/kg/24 hr as a continuous nasogastric tube drip (or given by intermittent gavage every 2-3 hr) for 5-10 days.If the initial feedings are tolerated, the volume is increased by 20-30 mL/kg/24 hr.Once a volume of 150 mL/kg/24 hr has been achieved, the caloric content may be increased to 24 or 27 kcal/oz.
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Pediatrics
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