Infant Feeding With Addiional Care Needs Flashcards
Principle 1 - review
Read- review notes ncluding recent asssessments weights and management plans
Identify risks for poor feeding and or hypoglycaemia. Gain a thorough history of
Listen - enable the parents to speak freely about their baby including their impression of how the baby is and how its feeding
Ask - for a SBAR handover from the previous midwife. Ask the parents both open and direct questions to complete a feeding history ask what the feeding goal is. Ask to watch a full feed
Preterm
Immature metaboli adaptions, lack of brown fat, low glycogen sores, limited ability for counter - regulation
Growth restriction
Lack of brown fate, low glycogen stores limited ability for punter-regulation
Maternal diabetes
Risk of transient hyperinsulinism resulting in hypoglycaemia. Baby is uses to high levels of blood glucose hence high levels of insulin
Maternal beta blocker
Transfer of beta blocker through placenta impairs glycogenolysis
Jaundice
At day 3-6 could be related to dehydration. Babies with jaundice should be assessed for reluctance to feed and lethargy
Sub optimal feeding means bilirubin is re absorbed on the small intestines rather than removed in meconium
Infection/sepsis
Interferes with the livers ability to synthesise glucose form substrates (glucogenesis) results in behavioural changes such as lethargy and poor feeding. Increases metabolic rate, increases o2 demands and increases risk of hypoglycaemia
Taking a. Feeding history
How often is baby feeding
How long for
How does feeding end
How is baby before and after a feed
Does baby show signs that they are hungry
Who determines when baby feeds
Is there a feeding pattern
How many stools/passsed urine
What colour were stools
Does baby vomit - what colour
How do breasts feel before and after
How much milk does baby drink
Reassuring findings of a feeding history
Frequency - first day of life - 3-4 feeds minimum. After first day of life - 8 feeds minium
Durations - 5-40mins
End - spontaneous unlatch/baby falls asleep
Cues= shows feeding cues before a feed the signs of satiety after a feed. Parents respond to baby cues
Pattern - include overnight feeds. Feeds do not need to be evenly spaced, but babies at risk of hypoglycaemia should not exceed intervals of 3 hours
Output - day +1 for urine increasing in volume. 1 stool in the first 24 hours a, then at least 2 stools a day. Stool colour changing by day 2, yellow by day 4-5. Posstein small volumes of milk is normal
Breasts - after day 3-4 breasts feel fuller before a feed and softer after a feed. Nipple shape remains unchanged following a feed and softer
Milk volume - dependent upon gestation and birth weight. Small frequent feeds better than large feeds with large intervals. Consider stomach size and metabolism 10-15ml/kg/feed as a rough guide
Principle 2 - assessment
Observe - look for jaundice, cyanosis, respiratory distress
Handle - pick up baby and assess for lethargy and poor time
Check - most recen weight. What is baby’s temp / o2 sats. Is a blood glucose test indicated
Refer- alert practice supervisor, involve neonatologist/ ANNP for babies requiring additional care
Observe a feed
Facilitate a calm and safe environment
Provide the parent and baby with personal space
Maintain their rivalry and dignity
Hands off
No interrupting
No judgement
Watch for - principles of positioning attachment, milk transfer
Principle 3 closeness
Skin to skin contact - babies who recieve this hav more stable blood glucose readings, heart rate and respiratory ability and ar more likely to initiate ans sustain breastfeeding
Staying with mum - babies rooming in with their USS increases mothering confidence and results in better breastfeeding outcomes
Responding to baby- maintain closeness enables parents to - recognise feeding cues early, responses to feeding and comfort cues, talk to their baby, touch their baby and learn about their babies needs
Responsiveness suppport enables neonatal brain development by boosting oxytocin evils nd reducing cortisol levels
What do oxytocin and cortisol lead to
Oxytocin promotes neural development
Cortisol hinders neural development
Principle 4monitoring
Feed charts - helpful short term measure for babies a risk of hypoglycaemia or poor feeding -not a long term measure
Blood glucose test indicated- term babiesayt risk of hypoglycaemia or poor; 2 consecutive measurements starting before the 2nd feed a over 2 feeds
Late preterm babies; at least 24 hours of pre feed blood glucose measurements
Neonatal hypoglycaemia >2mmol/L without clinical signs, >2.5 with clinical signs
Who is blood glucose monitoring for
Babies with a risk factor for hypoglycaemia
- small clinically wasted, diabetic mum or mum on beta blocker
OR
With clinical indication
- periencatl acidosis
Hypothermia not attributed to environmental factors suspected or onfirmed early onset of sepsis
Cyanosis
Apnoea
Altered level of consciousness
Seizure
Hypotonia
Lethargy
High pitched cry
Principle 5
Breast simulation - babies that are not feeing from breast at leat 8 times in 24hours
Expressedbreast milk - mothers own milk offered by syringe, spoon or cup
Donor milk - second choice to breast milk. It can be colonised with mums own breast milk to recreate her unique micro biota
40% dextrose gel - buccaneers adminsteration can erdue admission to NNU and quickly correct hypoglycaemia. A milk feed should be given straight afterwards
Value of breast milk
Treat hypoglycaemia
Provide immunity
Treat jaundice
Reduce neonatal stress
Relief pain
Mature preterm gut
To grow
To fight infections
Supporting relationship building with sick or premature babies
First minuet and of delayed cor clamping where parents can see and touch their baby
Birthday cuddle before nnu
Skin to skin contact
Providing breast milk
Room in in
Photos and mementos
Touch and voice
Support
