2017 Volume 21 Issue 1 Pages 20-26
The author delivered an extremely low birth-weight (631 g) female infant at the gestational age of 24 weeks and 4 days. The infant was discharged to home 164 days after birth, with a weight of 3,976 g.
Direct breastfeeding was difficult. Although she was able to ingest expressed breast milk from a bottle at a volume of approximately 500 ml/day, her intake per feeding was limited to approximately 40 ml, leading to the necessity of feeding at a frequency of 10-14 times/day. At the age of 209 days, as her milk intake began to decrease to 300 ml/day, resulting in weight reduction, nutritional management using nasal tube feeding was initiated at a volume of 600 ml/day. In consideration of future oral intake acquisition, we visited a dysphagia clinic when she was 292 days of age, and were instructed to perform swallowing training using gustatory stimulation to prepare for tube feeding. We were also notified of a possible shift of the feeding style to oral intake in about 1 year. The infant gradually became able to orally ingest small amounts, but her feeding function began to slow down at around the age of 400 days. Until that time, nasal feeding had been performed at a volume of 200 ml and intervals of 4 hours 5 times daily. From the age of 420 days, the interval was extended to 8 hours during the daytime to induce hunger, and the infant practiced oral intake. However, as her oral intake did not increase as much as expected, the nasal feed volume was reduced step by step from the age of 470 days, and this led to a gradual increase in her oral intake. The nasal tube was removed once weekly to confirm her daily oral intake, and the appropriate timing of tube removal was examined. At the age of 526 days, her feeding style was completely shifted to oral intake.
Although nasal tube feeding is effective for temporary nutritional management, this experience suggests the necessity of predicting the period of oral intake acquisition in the early stages of nasal tube feeding, and designing step-by-step approaches for it.
