Aspirating During Feeds

dmburr01

New member
My 39 + 6 baby girl was born on December 5 at 34 weeks. My water broke (PPROM) at 26 weeks and she stayed in until a scheduled C-section at 34 weeks. The biggest complication was underdeveloped lungs due to a lack of fluid for those weeks after my water broke. She made great progress at first and was removed off the oxygen two weeks ago, but ended up back on it at 1/4 liter with a humidifier last week. The doctors, nurses, and OT specialist believe this was likely because she is aspirating during her feeds. She is a voracious eater and was taking whole bottles on the Ultra preemie nipple, but definitely gets tired about half way through the feed and struggles to stay awake. The noises she makes and the fluctuation in her O2 stats is what makes them believe she is aspirating, even on the Ultra Preemie nipple. She would still generally finish the feed, but slowly. They do not think she is aspirating at the beginning of the feed, but rather at the point she gets tired and is “less focused” on eating properly. As a result they stopped giving her the whole feed by mouth. Now she gets 25 mL by mouth and the remaining 50 mL are tubed.

They did a swallow study yesterday to try and confirm this. However, they only watched her for 2-3 minutes at a time due to radiation constraints for newborns, and only watched the first part of the bottle feed on the Ultra Preemie nipple. They did not see any aspiration. They repeated the study with just a preemie nipple and saw silent aspiration.

They are taking no action at this point outside of the accommodations already in place such as a specific position for feeding, the ultra preemie nipple, and tubing 2/3 of her feed.

Has anyone else experienced this with their NICU baby? What did your timeline to going home look like?

I know she is getting great care, is where she needs to be, and will likely just need time to grow into these feeds. I’m hoping to avoid her getting a g-tube, but I also hate the idea of her staying in the hospital. With another kid at home, living at the hospital isn’t an option, so I’m feeling the Mom guilt for not being there all day, especially as she is acting more like a newborn and needs more interaction than she did as a preemie.
 
@dmburr01 An ultra Preemie is a very “therapeutic” nipple. AKA the flow rate of mLs/min is not fast enough to accommodate an entire feed by mouth if we keep their feeds to 30 mins and under (which we do in the NICU to avoid unnecessary caloric burn). It is wonderful she is not aspirating on the ultra Preemie and she can use it for pleasure and practice PO feeding safely. if she is aspirating on the Preemie, it is likely she will have a hard time maintaining her caloric need successfully by mouth. G tubes are scary but they really help some of our preemies who are struggling to eat. Sometimes it takes a few months to achieve safe oral feeding, in which they may need some extra help at home ❤️ praying for your baby
 
@dmburr01 We experienced this with my son. He really struggled with learning how to take a bottle and almost came home on a tube. He came home a few days before his due date & we had to pace feed with an ultra preemie nipple. After discharge we had to have 2 more swallow studies to determine if we could move up the nipple size. He was struggling to gain weight because the ultra preemie nipple was a lot of work for him. He’s 8 months now and thriving on a size 1 nipple! Feel free to message me with any questions.
 
@dmburr01 My son just had a swallow study earlier this week due to bradys during feeds, and the solution they found was using a thickened formula with a level 2 nipple. He instantly was able to successfully take full bottle feeds with no bradys or desats after that small fix! We went from possibly being in another month to potential discharge in 10 days! I also wasn’t at the NICU every day and had to wrestle with guilt due to that. Overall I had to accept that taking rest days for my own mental health would make me a stronger mother for him once he’s home! Definitely took time, he’s been in the NICU almost 3 months now.

Edit: additional info added :)
 
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