As an intern my experience was in a Level II facility, therefore shadowing in the Level III NICU has been a step up in my acute care experience and training with the pediatric population. The American Academy of Pediatrics (AAP) defines neonatal levels of care as (1):
Registered Dietitians are essential in following the feeding transitions of very preterm and extremely premature infants in the NICU. Infant feeding transitions from birth to 1 month set the foundation for achieving feeding transitions through childhood. Successful feedings during childhood influences healthy eating patterns throughout life. (2)
Feeding transitions are defined as "periods of time in which infants move from one type of feeding to another." The actual age of achieving milestones varies infant to infant, but feeding transitions build upon one another (2). When infants miss milestones the likelihood of feeding difficulties increases. If infants are spurred to meet milestones before they are developmentally ready, feeding problems may also occur (2).
There are seven major feeding transitions for term infants (2):
Prematurity is associated with unique nutrition-related issues, therefore feeding transitions are more complex (3). The gastrointestinal tract becomes functional and the sucking reflex develops between 32-34 weeks gestation. Aggressive nutrition therapy, such as parenteral nutrition, should be initiated immediately for very preterm and extremely premature infants. As the GI tract matures and reflexes develop, feeding transitions to nasogastric (NG) feedings and ultimately oral feedings (PO) of mother's breast milk or formula.
Delivery of nutrients into the circulatory system, or parenteral nutrition (PN), is used to maximize nutrient intake once PO or NG feedings are established. Fortifiers and supplements are often used, as unfortified human milk does not contain enough nutrients for infants born prematurely. Adequate calories and protein, as well as several other micronutrients and electrolytes, results in greater short-term weight gain, length gain, and head growth (3).
Shadowing in the NICU has been an exciting experience, and I am learning more with every day. There is no greater satisfaction in acute care nutrition than helping patients and their families get the best start in life. Registered Dietitians monitoring feeding transitions provides a building block for life, and has the potential to promote a healthier future for generations to come.
1. Levels of Neonatal Care. Pediatrics. 2012;130(3):587-597. doi:10.1542/peds.2012-1999.
2. Milano K. How Infant Feeding Transitions Relate to Feeding Difficulties in Young Children. Pediatric Nutrition - A Building Block for Life. 2016;39(2):1-6.
3. Perkey KG, Mathis MT. Neonatal Nutrition Support. Nutrition Dimension
4. http://www.marchofdimes.org/pregnancy/what-is-full-term.aspx. Accessed February 26, 2017.