This study aimed to determine the feeding management of preterm infants in the Bicol Medical Center, Naga City. It focused on the infants' physiological profile, effectiveness of the feeding management in the hospital, so that a nursing intervention plan can be proposed.
Study design: Descriptive research method
Study setting: Bicol Medical Center, Naga City
Study population: The subjects of this study consisted of preterm infants born in Bicol Medical Center, Naga City from January to March 2009. The respondents of this study were neonatal/NICU nurses who took care of the preterm infants.
a. The gestational age of the preterm infants ranged from 25 to 36 weeks with average of 32.16 weeks or about eight months old. Their weight was between 1.0-2.5 kilos, while the length ranged from 27 to 46 cm. or average length of 25.91 cm, which was half the length of a full term infant. The average head circumference of the infants was 29.45 cm compared to the average head size of a full-term infant which was 35 cm. Most of the infants had a head circumference between 30-26 cm, followed by nine (30 percent) with head circumference between 35-26 cm. Only one (3.33 percent) had a 36-41 cm head, while the smallest (3 or 10 percent) had only 25-23 cm head circumference. In terms of stomach capacity, nine or 30 percent of the infants had stomach capacity between 35-30 ml per feeding, fifteen or 50 percent consumed 20-25m ml, and six or 20 percent consumed 10-15 ml per feeding. Out of 30 infants, 19 or 66.33 percent developed sepsis; only 11 or 36.67 percent had not complication.
b. In terms of readiness for nipple feedings, twenty-three (76.67 percent) had no rooting reflex, 29 (96.67 percent) sucked on gavage tube, finger, or pacifier. All were able to tolerate holding. Twenty-nine (96.67 percent) had respiratory rate <60 breathe per minutes. All had presence of gag reflex. On the infants 'signs of non-readiness for nipple feedings, one each (3.33 percent) had respiratory rate >60 breathe per minutes, no rooting or sucking, had absence of gag reflex, and excessive gastric residuals. The adverse signs during nipple feedings were tachycardia (all infants or 100 percent), increased respiratory rate (29 or 96.67 percent) , markedly decreased oxygen saturation level (100 percent), apnea (29 or 96.67 percent), falling asleep beyond 25 to 30 minutes (100 percent). No infant had bradycardia. All infants could tolerate quite well nipple and feeding tube. All infants received nothing but their mother's breast milk. All infants were given breastfeeding, but 16 (53.33 percent) also received gavage feeding, and fed every three (3) hours, 7-9 times a day, with breast milk.
c. All infants showed increase in oxygen requirement, metabolic and survival rate, but after two days of feeding, all infants failed to develop weight gain, nor increase in length, head growth, nor improvement in sucking reflex, swallowing reflex. All infants developed necrotizing enter colitis due to immature gastrointestinal tract, while 19 developed neonatal sepsis.
d. The intervention plan proposed feeding management based on the physiological development of the infants, and information gleaned from reviewed materials like fortified mother's milk.
a. The preterm infants are below the normal gestational age, weight, head circumference, stomach capacity; most of them develop neonatal sepsis.
b. Majority having no rooting reflex but they could breastfeed or suck through gavage tube. Among the signs of non- readiness for nipple-feedings are fast respiratory rate, no rooting or sucking, absence of gag-reflex and excessive gastric residuals. They have decreased oxygen saturation level, apnea, gagging, and falling asleep for half an hour. All can tolerate nipple and tube feeding, having received nothing but their mother's milk. Feedings techniques used are breastfeeding and gavage every three hours.
c. All infants showed increase in oxygen intake, metabolic and survival rate, but after two days of feeding, all infants fail to develop weigh gain, nor increase in length, head growth, nor improvement in sucking reflex, swallowing reflex. All infants develop necrotizing enter colitis, while more than one half develop neonatal sepsis due to weak immune system and exposure to nosocomial infection.
d. The results of the study reveal the need for more enhanced feeding management system and prevention of nosocomial infection to increase the survival rate of preterm infants.