Apropos of last week’s post, in which I talked about choosing to feel blessed rather than cheated by this alternative newborn parenting experience, I must say that the topic of feeding my baby tests my resolve.
Besides not being able to hold him right away, waiting to feed Jax for the first time is just short of agonizing.
But: “blessed.” I remember.
The timeline for being able to feed by either bottle or breast for a NICU preemie relies on many factors. First, is the baby tolerating tube-feeding well? Is he gaining weight? If yes to both, then the baby’s digestive system is developing as it should be.
Next, how is his breathing? Is he at least on a low level of breathing support? Coordinating breathing, sucking and swallowing is challenging for all newborns, but especially so for preemies. A fast rate of breath will make it even harder for these tiny babies to nurse successfully.
But there are other factors the NICU doctors use to determine a preterm baby’s readiness to lose the food tube and “graduate” to bottle or breast.
Right now, Jax is receiving a combination of breast milk and a high-calorie supplemental formula with probiotics every two hours. Before administering that little preemie cocktail, nurses look at Jax’s behavior, what they call his feeding “cues.”
Is he awake? Alert? Are his eyes open, and is he looking around? Is his tongue out? Is he making sucking motions and noises? Is he rooting, moving his head around to find me? (Ouch. Heart pangs.)
There are four levels of cue behavior, and at every feeding, Jax gets what’s called a cue score. Nurses record those scores, and once he’s consistently in the 3 or 4 range, they determine his readiness to try breast- or bottle-feeding.
Last week, Jax was receiving 3s and 4s, but his breathing rate was too high. As soon as it comes down a bit, I can feed him. That will be a whole other challenge, but for now, his team assures us that he’s developing appropriately for his age.
In fact, Jax is ahead of schedule. Most babies don’t develop hunger cues before 37 weeks. Jax is 33 weeks now and could be ready to nurse at any time.
Once preemies wean off their feeding tubes, they get a feed score at every meal, similar to the cue score. Receiving 3s and 4s on their feeding scores, among other things like a week with no alarms and weight of at least 5 pounds, are a determining factor for discharge.
Yes, discharge. The doctors and nurses are starting to discuss a timeline for Jax to come home.
Just the fact of this discussion is a Christmas present for Jon and I.