DAY 4 - STILL GOING STRONG - EARLY ENTRY INTO THE WORLD - DAY OF DELIVERY (PART 2)

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(Continuation of article titled EARLY ENTRY INTO THE WORLD - DAY OF DELIVERY by Dr. Narasimha)
PART 2 
 

I got my first feedback for my previous article, from a senior colleague of mine, it sure has pumped me up! Well, thanks for the kind words.

 

 

Our precious NICU lil one is fighting all odds, its posed against. It has fought and conquered first 4 days and its quite a progress. After the initial fears of possible lung immaturity, left behind cautiously, next step is to fight the biggest killer, Neonatal sepsis.

Best way to prevent it? Dont touch the baby. Its us who induce infection and all kinds of germs into the baby n kill it, rather than it being handicapped with immune defense mechanisms. NICU staff have been very cautious and the minimal handling is the rule. Handwashing, barrier clothing, minimal or restricted handling the baby have been a ritual. As if immaturity were to be the excuse for all organ systems, so be it, here too. Immature immune defense system, both humoral and cellular contribute to baby's inability to handle microbes.

Next step up the ladder is to introduce mother's milk. As it goes 'breast milk is the best milk'. Here we tread cautiously. The gastrointestinal tract, its accessory organs, their functions aren't ready yet to accept their role in life. i.e to breakdown complex nutrients and assimilate them. The enzymes are not yet synthesized and 'friendly' gut flora - the normal commensal bacteria, which aid in digestion have not colonized and hence the tract is raw. Mild contains glucose (human milk is supposed to contain higher proportion of carbohydrates making it the sweeter milk than cow's milk) and glucose adds to a bit of osmolality (recollect biochemistry). High osmolality relative to immature intracellular envirionment of GIT can suck off the water in cells into lumen, rendering cells to die. This is one of the mechanisms implicated in a condition called 'Necrotizing Entero Colitis - NEC.

Physical immaturity in the form of poor jaw musculature causes weak suck reflex. The suck and swallow reflex have to be well coordinated in order to 'take in' the feeds. In prematures, suck and swallow are at different phases and aint quite coordinated. More ever, making a premature suck, burns up more energy than the energy it would have gained by drinking that quantity of  milk.

All these factors modify our decision as to when is the right time to initiate feeds, how to introduce the feeds and how to meet the energy/ nutritive demands for that age.
We did initiate by introducing small quantity 'expressed breast milk' at frequent intervals and slowly progressed by increasing the quantity and frequency. We started off feeding via spoon/ paladey and are continuting it with it presently.

Presently we are able to meet less than half of energy and fluid requirements via the 'minimal enteral nutrition' - expressed breast feeds and the rest from iv fluids. We do hope to make progress cautiously and aim to achieve full nutrition and fluid requirements to be met via breast feeds within next one week (fingers crossed!) And then provided the jaw musculature is strong enough to suck milk and efficiently siphon it into gut, we will introduce direct breast feeds.

So people, rest in next. Meanwhile lets pray, hope and wish for the best!
DR. NARASIMHA - KANNUR MEDICAL COLLEGE
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