NICU nighttime feedings

My boys are 34 week grower/feeders. The only thing they have is a feeding tube. They're four days old. I can only visit once per day right now and it's killing me. I always schedule it so I'm there for a feeding. Josh is doing great with the bottle. He's getting 35ml per feed, takes about 15-20mls, rest goes in tube without much left undigested. Matthew on the other hand is still catching on the bottle. He's doing much better but still is learning. A lot more goes in his tube and he's doing pretty good digesting. So, everytime I go I hear they were sleepy overnight and wouldn't take the bottle so they were fed through the tube. Mainly from Matthew not Josh. I get they're four days old and trying to eat burns energy but I'm starting to wonder how much they are trying. Anyone have this issue?

 

My babies weren't technically premmies so bear that in mind about my experience. We always had issues with the night staff using the NG tube instead of trying with the bottle (which we needed Sierra to get the hang of so that we could get her discharged once she mastered the suck swallow reflex). My feeling was that being understaffed made it difficult for them to spend the time feeding with the bottle.

I so know how difficult it is to get to the hospital when you have littlies at home. This is what I would suggest if you are able to... if you are only able to get there once a day (as I was) try to be there for two feedings a day. So try to get there just before the first feeding or CARES so that you can spend some time changing them before their feed etc. Then once they are back to sleep, go for a little walk, have a snack, watch them sleep then do the next feeding. This will give you the opportunity to make sure that they are fed by the bottle. See if you can also time it one or two days per week that you are there for their bath during this time.

What I also did, was each day find out which staff would be on at night, and I would give them a call about 8pm and just casually mention, how important it was to me that a bottle feed was given. I was expressing so it was doubly important to me that they were aware that plenty of breast milk was in the freezer.

It is so hard doing the daily NICU trip -I always felt on the verge of tears - I feel it even now as I write this and it's been over a year! Be strong and remember they are YOUR babies and you have every right to have an input into their care as much as the staff do.

 

Thank you. As soon as I can drive I'm either going to do as you say or make two trips. It's so frustrating. I'm hoping today's slide was them tinkering with their feeding because of the time change. Yesterday I seemed brushed off when I called at 8pm for an update. Tonight I'm going to call at 10 cause they've had their 9pm feed by then. I'm just stuck and feel helpless because even though I have every intention of going more I might not be able too.

 

If you have concerns about night feeds, push for answers. We had a good nicu experience, but I've heard this about night nurses from so many people. Don't be afraid to demand answers.

:grouphug: You can only do what you can do. Don't be too hard on yourself for being pulled in many directions.

 

I just got an idea. The boys eat at 3,6,9, and 12. If I keep hearing about them using the tube at night im going for their midnight feeding too. All the kids would be in bed and dh would be home. He has to leave at 3am for work and I would be back well before that. Ideal? No but I'm not letting them mess with their feedings.


ETA: today I noticed something different too. Usually, they pull the undigested formula from the ng tube then re-feed after the bottle but today she fed it while I was giving the bottle. Wouldn't that cut the amount he takes if he's got formula coming two different ways?!?! Wouldn't it be better to wait and re-feed that formula with what's left over from their bottle? I know that probably only happens when I'm there though cause they can't do both alone. Hmmm I might ask about that one. Im going to ask they let them eat first then re-feed. She did that yesterday.

 

Just don't burn yourself out! You need to rest too, especially with c-section, take it easy please.

When you call at 8pm and they seem really busy, ask them what time would be best for you to call back - try and build up a relationship with at least one night nurse you feel comfortable with.

 

Oh my gosh that was my biggest pet peeve!! So many nurses would just drop the feed and then tell me the she was too sleepy to eat!! One day I walked in (I always went way too much and they knew I was coming in to try to nurse her) and caught the nurse dropping the feed. It was five mins before she was due to eat. She apologized but I was so upset!!
Also, there is a lot of controversy about pulling back to see how much is left undigested. My nicu stopped doing it past a certain gestation bc they said the only reason to do it when there was a valid concern of a digestion issue (nec or something like that). Many drs feel it isn't healthy to pull it back up.
Def try to go in at that midnight feeding if you feel up to it, at least just once to see. If not, talk to your nurse manager about your concerns, see if anything changes!

Congrats and hope their time there is short!!

 

I know the doctor is for the pull back because when I was there yesterday the nurse had to ask if they wanted to re-feed in addition to the bottle or just give the re-feed. I was going to insist on doing the bottle because DUH isn't the point to learn to feed from a bottle??? Josh took 20mls yesterday then was fed the remaining 13mls from his bottle AND re-fed the remaining amount which was something crazy like 10mls. Then you wonder why there is a lot left the next time?!?!!? He's four days old!! I'm beyond frustrated. Tomorrow I'm going to ask more questions. Right now I'd go tonight for the feeding but I can't drive yet. I need off this oxy first. I feel so much better from getting the staples out that I think I'll be able to back off the oxy starting tomorrow. I'm just going to try tomorrow to see. I won't let myself be miserable. It's making me feel a bit loopy when I take it so I think it's just too much. I just want to scream and cry but I know that won't help.

ETA: Our plan for tomorrow was when DH got home was to go to my IL's, eat dinner, then go to the NICU. I'm thinking I'm going to have dinner ready in the crock pot like I planned but I'm going to have him drop me off at the NICU first, then take the kids to my ILs, eat, etc. then come himself. That would be two feedings I would be there for and change of shifts for the nurses. I feel bad for my other children but it's only temporary until their brothers are home.

 

- stay strong and look after yourself. NICU time is so frustrating as everything seems out of your control. What time do the doctors do their rounds in the morning? Try to get in there for then so that you can be there to ask questions specifically from their doctor. Hang in there! :hug:







.

 

Thank you! I'm so happy for twinstuff and a group of people that understand!!! The doctor does his rounds early and I cannot be there that early. It would be too hard getting the kids up and out early and I also homeschool so it would mess with our school time. I can't take too much time off.

 

:woman: That way you know for sure!

In our NICU, the staff usually had the same babies two nights in a row. And tended to rotate between 3 different nurses.
So ask about the schedule.

Maybe you have a really good feeling about one nurse and you can skip one late night. Or maybe you can get someone to give you a 'heads up' on which nights it would be most 'helpful' for you to be there (aka one lazy nurse). If you word it like... 'I can't get here every night with my kids at home. do you know if there is one night where you might be a little shorter staffed. I could try to get here on that night. I so want them home with me and I know learning to bottle feed is so important. You all do such a good job but i imagine there are times when the extra time it takes to bottle feed is hard on top of everything else you have to do.'
You never know.. it never hurts to ask.

Glad you are going to do a late night visit. You have every right to expect answers. Sometimes, just asking enough questions so that they know you are paying attention is enough.

I have to say, our experience with the NICU nurses (night and day shift) was wonderful.. I hope you get the answers you are looking for, I also hope you find out they are a great group of nurses, so you can feel more relaxed about leaving your babies in their care. It is hard being separated.

 

Just a heads up. I don't know if every NICU does it this way but.. they kicked parents out during shift change because they had a meeting and discussed all their cases. (medical privacy concerns) It wasn't for a long time but, just in case, I wanted to warn you. could be frustrating to get kicked out (even for a minute) when you weren't expecting it.

 

My next question is how long did you wait to drive. I need to cut out the pain meds. The nurse that came to the house tonight said yes the recommended time is 2 weeks but it depends on how I feel. If I cut out the pain meds I'm thinking I'll start Wed/Thursday. That would be a week.

 

I felt like I could drive 2 weeks after, I was off the meds within a week, but they weren't that strong anyway - not strong enough to worry about driving. I waited until 6 weeks before driving because of insurance reasons. Most insurers will not insure you for the first 6 weeks after a major surgery which c-section is considered to be so you may have to check with your insurer.

Does your NICU allow children as visitors?

 

I never knew about the insurance thing until today. My doctor said two weeks so I would assume if I'm cleared by the doctor after two weeks then the insurance should accept that?! I'll call tomorrow and see what the insurance comp say.

 

perhaps that is an Australian thing but I was an insurance agent for years and there is no policy restriction for driving after surgery...the only concern is if you are on narcotic medication and have an accident or get pulled over you can get a DUI with narcs in your system...

as for the amount of feeds that is CRAZY!!! Babies tummies are only the size of their fist - which is why if you feed a baby more thank 20-25 ml's at a time they throw it back up! or you wind up with gastric residual...

when you say re-feed, do you mean they pull it out of their stomach and then feed it to them again? That's VILE!

 

I totally agree!!! It's disgusting! I'm going to talk to the nurse about it more tomorrow. I'm going to ask nicely how it is they expect them to digest so much at one feeding. Actually I'm going to ask a lot of questions tomorrow. I'm getting ready to call and I know I'm going to end up in tears if they tell me they haven't ate much.

 

if they are pulling up enough gastric residual to re-feed it to them then they should hold the feeding! In adults if there is enough gastric residual they don't feed them! Not to mention the fact that they are re-feeding them the gastric juices....OMG that is the most bizarre thing I've ever heard! If they can take 25 ml by mouth every 3 hours then they should be able to keep them on the bottle...if calories are a concern they should be getting either 22 calorie or 24 calorie formula - or fortified breast milk (not sure if you're pumping or not)...also - not to defend the practice but the nurses may not have time to sit and feed them at night - and they do need to sleep well to grow...

I"m sorry sweetie...that's a load of crap!

 

Hahah, yes probably an Australian thing, but I was sure an American friend of mine said that her policy had something similar - perhaps it depends on the insurance agency? I know some agencies here vary from getting the OK from the doctor, to restrictions being lifted after 2 weeks or in our case, it was 6 weeks - policies differ so greatly between agencies! It would definitely pay to double check.

 

Bingo. Do not take it all upon yourself. This is THEIR job. I had the same problem. My boys were 35 and 2 and were born at 6 lbs each. They were eating like champs but the night nurses were lazy and put tubes in them so they could sit on the internet! I'm not kidding. I would catch them and I finally had enough. I went to the charge nurse and 24 hours later my kids were off the tube and home. Amazing. LOL. Just make sure they know that you are aware of what's going on even if you are not there. Good luck!! Congratulations!

 

I called last night and got an awesome lady. She seemed like it. She explained more than most. Not that she has many answers but she wasnt brushing me off either. I ended up crying over the phone so she knows how important this is to us. Not to say she won't just feed them through his tube too bit she didn't like the amount of back up in his tube and actually had the NP look at him.

My questions today:

-How long do you work with them on the bottle?
-Is pulling and re-feeding back up necessary? Can u just feed the 35mls each feeding? Like bottle then tube without the back up.

I'm sure I'll have more but this is what I got so far. I'm going to try to talk to the NP myself. The nurses are wonderful but they don't pull the shots.

 

They think I'm coming today at 6pm feeding but I'm actually getting there at 3pm. Ill be too late to feed Joshua but she should be just starting his feed and if she's doing anything else I'll know they didn't try. I will be able to feed Matthew and he's the lazier one so that's good. I'll be there for two feedings today!!!

 

I was there for two feedings tonight and got more answers. The nurse practioner came in. They give the boys 15mins for the bottle then tube feed the rest. I'm not going to argue that at this time because that's what the boys for me. Us, they're taking the same or just slightly more for me than the nurses so I'm feeling more comfortable that they're actually feeding them. They're not pulling and feeding residual formula anymore especially they're digesting the majority of it. She did pull Matthews tonight once just cause he spit up but it was only like 1ml. Both boys are increasing but have a ways to go. I need to accept the fact they will be there the three weeks they have said all along. Since they came out doing so well I allowed myself to think it would be sooner. Likely not going to happen. I'm prepping myself for the week of thanksgiving which is 37 weeks.Of course Matthew is really taking his sweet time learning to suck so he might be longer.

 

Hey Christina, sorry I didn't notice this thread before. My girls were in the NICU also as grower/feeders and I was also really unhappy with the NICU and how they were feeding them, specifically Chana'le. It is so so hard!! Something I remember being really useful is using non-confrontational phrases to tell the nurse or NP that you are unhappy, like "I'm really uncomfortable with... and would prefer..." or "I don't feel like ... is the best thing to do, can we do XYZ/can you explain it me again/what are the other options?" I also found that the lactation consultants in the regular maternity ward were the most helpful in explaining things to me and giving me tips on which ARNPs were the best to talk to. Another thing was to always thank whoever you are talking to for their time, they will feel appreciative for that and more receptive to what you are saying. Also, at night 10 pm is the best time to call if the shift change is at 7. At 8 they are getting ready for the 9 pm feeding and are too busy to talk. 10 pm is right after the feeding so it's a little quieter. And if it really gets down the wire, don't be afraid to be firm!! They are your babies and the final say is really up to you. Keep going higher up the chain till you get what you want. I hope this helps.
Miriam

 

At that age I wouldn't worry about it too much. Perhaps one time you can make your visit for the night time to see how they do at night for yourself. My guys were never good eaters until they were much older. I just did a post that k almost came home with a feeding tube. literally up to about 30 min before we left the hospital he was still on a tube. Nikels was a much better feeder once he was a bit older. K really never was a good eater until he was a month old.