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Enterally Feeding Neonates

In her 27 years of NICU experience, Mary Puntillo, RNC-LRN, RNC-NIC, has learned much about respecting the individual needs of infants - noticing their cues, helping them grow and delighting in their successes.

Supporting an infant's growth and nutrition through enteral feeding provides an opportunity for nurses to exercise all these skills as well as utilize the clinical expertise that can lead to optimum outcomes.

As the neonatal nurse clinician for Community Health System, Munster, IN, Puntillo shares her knowledge with colleagues to help ensure positive results for their tiniest patients.

A variety of factors might contribute to the necessity for an infant to be fed enterally, Puntillo explained.

"An example [of an infant requiring enteral feeding] would be a preemie who is not yet able to coordinate the suck/swallow/breathe reflex. Premature infants are known to suck but 'forget' to breathe and swallow," she said.

"Sometimes an intubated infant or an infant with a weak or absent suck requires a feeding. Whatever the reason, enteral feeding is meant to assist infants as they grow, heal and mature so they can coordinate those skills necessary for successful feeding."

In some cases, an infant may have mastered their suck/breathe/swallow coordination, but the baby is burning more calories than he is taking in.

"It's a fine balance," Puntillo said. "We have to ask if we are burning up so much energy just for the sake of eating that we're not working toward the ultimate goal - getting bigger."

Ideal Placement

According to Puntillo, placement of the tube is typically quick and painless with neonates, as they usually do not yet have strong gag reflex. The tube may be inserted nasally or orally, a choice dependent on other interventions currently at work.

"If the infant has a nasal cannula, for instance, we're not going to put a tube in the nose," she said.

In that case, the tube would be inserted through the mouth. In all cases, the tube must be carefully measured before insertion.

Following placement, the exposed portion of the tube is taped to the infant's skin, "so little fingers can't get underneath; we know that babies like to yank those tubes out," Puntillo said.

As with any procedure, enteral feeding has its risks.

"That's where safe care comes in," Puntillo said. "Prior to each feeding, the [tube] placement is checked and we are monitoring to make sure the infant is digesting his formula or breast milk. We can aspirate on the feeding tube to see what is left from a previous feeding, make sure the baby's belly is not distending, that it's soft and there are bowel sounds, and that things are progressing right along."

The tube material itself should be a considered for safety and comfort. Puntillo noted the tube naturally must be made of a very soft material, and alternatives to plastic can provide benefits for the patient. "Plastic will be more erosive to the tissue in the gastrointestinal tract, and also must be changed every other day," she explained.

She prefers Silastic tubes which are softer and more pliable than plastic tubes. The Silastic feeding tube can stay in place for up to 30 days. "You can tell in the handling that the babies are less comfortable with plastic; with Silastic they barely know it's there," Puntillo said.


Enterally Feeding Neonates

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Do you present on this subject at professional conferences?
thank you

Marjorie Palmer,  Neonatal Feeding Specialist,  Kaiser PermanenteNovember 20, 2013
San Francisco, CA




     

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