Neobook — clinical reference

Description

When a baby has an acute respiratory infection – it is particularly worrying if the baby is not able to take at least half of their normal feeds. (Most viral illnesses are short-lived and an otherwise healthy baby should be able to catch up on feeds afterwards.) Enteral feeding is much safer than intravenous (IV) fluid therapy – and is always preferable in babies.

The poor feeding can be due to a combination of factors, such as:

Blockage of nose with secretions – when babies suck they need to be able to breath air in through the nose. They may need help clearing sticky secretions from the nose.
Energy is required to suck and to digest milk – if the baby is already using lots of additional energy on breathing, they may not have enough energy to feed as well.
Fast breathing makes coordination of sucking, swallowing & breathing difficult and this can result in choking and/or aspiration of milk.
Loss of appetite – just like adults babies may not feel like eating when they are sick. The problem is that babies do not have large stores of energy so if they don’t feed well they can quickly become hypoglycaemic and more unwell.

If the baby is having difficulty feeding due to a respiratory illness – and there are no contraindications to enteral feeding (e.g. imminent respiratory failure, marked respiratory distress, possible surgical condition) – the following steps may assist in avoiding IV fluids.

Stepwise Assisted Feeding Plan

Step 1: Little & often oral*

Offer feeds more frequently and allow the baby to take as much as they can. For example: if the baby normally feeds 120mls every 3 hours, ask the mother to offer 80mls every 2 hours. If breastfed – ask the mother to offer the breast more frequently and let the baby rest when he/she looks tired. If the baby appears to be tiring when sucking – then the milk can be offered by cup & spoon.

Step 2: Hourly feeds oral*

If the baby is not able to take adequate amounts in step 1 – give even smaller amounts but more often. In the above example: 30-40mls/hour by cup & spoon or hourly breast-feeding.

* Continue as long as the baby is taking (& retaining) at least 50% of normal feed volume

Step 3: Hourly feeds NGT

If Step 2 is failing or not possible (e.g. mother not present – or not able to offer hourly feeds) – then site an NGT and give the hourly (or 2 hourly) amount via NGT. (Note: breast milk can be expressed and given via NGT – this is far preferable to formula if available).

Step 4: Continuous NGT feeds

If the baby is not able to tolerate hourly NGT feeds (vomits, or respiratory distress worsens after feed) then put the baby on continuous feeds using a pump or syringe driver.

Step 5: IV fluids

If the baby is still not successfully managing enteral feeding with continuous NGT feeds or if the baby’s condition is worsening – then they are likely to need IV maintenance therapy.

NOTE:

If the baby’s condition is worsening or there is extreme respiratory distress – then it is unwise to persevere with enteral feeding. Energy is required not only to suck the feed but also to digest milk in the GIT. Babies who are in a precarious condition need to be relieved of this additional ‘work’ and the consequent oxygen demand.

Always try to maintain breastfeeding throughout the illness – even if the breast milk is expressed and given via cup & spoon or NGT