Neonatal Intensive Care

Several physiologic variations differentiate the typical pre-term newborn from the typical full-term newborn. Three such differences are described in this section (Todres & Fugate, 1996).

Poor infant weight gain is one physiologic difference between the typical pre-term newborn from the typical full-term newborn. A normal full-term newborn may lose up to 10 percent of body weight in the first few days of life, but should regain to birthweight by 10 days and follow a growth curve thereafter (Todres & Fugate, 1996). Frequently, a pre-term infant will be found to not be gaining weight adequately when checked at 10 to 14 days of age. At this time, the cause of inadequate intake should be evaluated.

Infant jaundice is a second physiologic difference between the typical pre-term newborn from the typical full-term newborn. There is clearly an association between breast-feeding and high levels of serum bilirubin in the first few days of life. In full-term newborns in the absence of hemolytic disease, however, hyperbiliru-binemia has little clinical significance (Newman & Maisels, 1992). There is no evidence that breast milk itself causes early jaundice; rather, caloric deprivation and delayed stooling have been implicated.

The syndrome of "breast milk jaundice" has its onset after the third day of life, peaks at five-to-15 days, and appears to be caused by substances in th

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hereafter with normal growth patterns. If weight gain remains inadequate, or if at any time the infant appears to be dehydrated, breast-feeding must be supplemented with an appropriate formula (Kempe, Silver, O'Brien, & Fulginetti, 1992). Prompt weight gain in response to supplementation reassures parents and health care providers that the baby is essentially healthy and buys time for further development of maternal breast-feeding skills. If weight gain remains inadequate with supplements, however, underlying chronic illness or other causes of failure to thrive should be considered (Pless, 1994). With respect to infant jaundice, there is no evidence that breast milk itself causes early jaundice. Rather, caloric deprivation and delayed stooling have been implicated. In infants who nurse more than eight times per day tend to have a significantly lower mean bilirubin level than do infants who nursed less frequently. Increased frequency of nursing (every two-to-three hours around the clock), with attention to the effectiveness of the infant's sucking is the most appropriate management (Todres & Fugate, 1996). Ordering supplemental water, a common intervention, is not likely to be useful, as unconjugated bilirubin is not water-
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