[Dysphagia] [asha-div13] NICU preemie

[Catherine.Shaker at wfhc.org (Shaker, Catherine S.)]

Hi Rebecca,
Thanks first of all for the kind words about my NICU seminar ! 

It would be helpful to have more history, especially respiratory course,
progress with feeding to date, how often baby is nippling, is there an
indwelling NG...etc. 
History helps to drive the questions as we problem-solve and make sense
of what we see.

Sometimes babies who look "ready to go" have reduced "drive" to feed.
This may be respiratory, i.e. very subtle increase in work of breathing
may result in purposeful use of short sucking bursts.
This may be schedule related, i.e. when did the baby last feed? Is it
possible she was not really that hungry?
At 38 weeks many babies are on demand schedules, and research shows
intake does increase after about 48 hours on a demand schedule.
This may be GI related, i.e. if baby has delayed gastric emptying, which
can be an etiology for GER, hunger may be blunted.
However many premies with GER do not evidence a reduction in appetite.
If there is an indwelling NG, it keeps the LES open, and can act as a
conduit for reflux. Research has also shown that presence of an
indwelling NG tube adversely affects sucking pressure and intake.
So there are many possibilities for what might be going on.

It is difficult to fully understand a baby's feeding and swallowing
skills after only one observation.
See her again and compare/contrast your observations and her behaviors
over time.
Talk with nursing about what variability they may be seeing.
When you feed her next, look at the trend in nursing documentation
regarding whether there were times her volumes were greater. What appear
to be the variables operating then? Of course, one would need to filter
out whether prodding was a factor, which hopefully it was not; often,
infants with decreased drive  to feed are, unfortunately, targets for
well-intentioned prodding.
Think about whether subtle respiratory, GI or schedule-related issues
are at work and perhaps are not as obvious but playing a part.

Keep us posted on  what you conclude :-)
I find that working with babies in Intensive Care is very much a
problem-solving endeavor----digging through the details of the history
and medical course, watching, listening, feeling, looking at variability
over time, analyzing and integrating nursing observations, and "peeling
apart the layers" that may contribute, if you will.

The babies often lead my thinking in the right direction if I ask the
right questions.

Catherine

Catherine S. Shaker M.S./CCC-SLP, BRS-S
Manager - NICU/Pediatric Rehabilitation
Wheaton Franciscan Healthcare - St. Joseph
5000 West Chambers Street
Milwaukee, WI  53210
414-447-2797 Phone
414-874-4104  Fax
Catherine.Shaker at wfhc.org


-----Original Message-----
From: Scott Lindsay [mailto:s0981 at rock.com]
Sent: Monday, March 12, 2007 2:37 PM
To: Division 13 Discussion List
Subject: [asha-div13] NICU preemie

Please help with my little 30 wks (GA), now 38 wks (PCA) twin. Her
brother did fine and went home. She was admitted to NICU secondary to
prematurity as well as respiratory distress. She has GERD.
I went up for the eval. to feed her and she looked GREAT. There were NO
signs of distress whatsoever and she was alert; however, she would suck
twice every so often and then just look around quite pleasantly. I gave
her to her nurse to watch what happened and it was the same thing.
I went to Catherine Shaker's AWESOME course, as well as a couple others
and thought I knew what to do, as far as pacing if they are distressed,
etc. but I guess I don't know wbat to do when there are no signs of
distress. She just didn't really seem like she was interested in her
feedings.

Thanks for your help,
Rebecca

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