Ask Drew: Feeding

Leigh said...

Hi J & D. Why is the nutrient mixture bad for the liver and kidneys? Does he receive some milk as well?

Standard practice for babies in the NICU is to make sure they get a certain amount of nutrition, depending upon age and size. This nutrition can come in many forms, but they generally want it all to add up to a particular amount....in Andrew's case, 25cc per hour. This is approximately the volume that he would be getting in milk if he were feeding normally. The feedings that I have been mentioning (currently at 8cc per hour) consist of breast milk that is dripped into his GJ (gastro-jejunal) tube. This is processed in the normal fashion by his digestive system, which extracts the nutrients in the most natural manner possible and delivers them to the blood.

There are two other drips that also contain glucose, running at 1cc per hour each. That means the remaining volume (15cc) has to be made up somehow. The solution is TPN, a bag of yellow nutrients including salts, glucose, amino acids, and vitamins. This is dripped directly into his bloodstream through one of his lines. Since it isn't exactly the natural process of providing nutrients to the body, it can cause problems with the liver, including cholestasis due to gallstones. This isn't an immediate threat, but long-term use of TPN can cause problems. It's different with every child and not necessarily irreversible, but it's definitely better to switch to milk as soon as possible. They're not worried about these problems right now, especially not enough to risk the reflux that could be caused by too much milk. They plan on going to about half-feeds (12-13cc per hour) and holding stable until they can do the stomach valve surgery.