The Nutrition Room

I spent the morning in the Nutrition Room, watching and then helping the two techs fortify human milk and mix up formulas for the neonates. It is really well organized to prevent anyone from accidentally giving a mother’s milk to the wrong baby (which, per JHACO, is a sentinel event, eg, an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.)

The techs get orders from the MDs or RDs and then check their recipe lists to add in extra protein and calories. Human milk is about 22 kcal/oz. Neonates may not be able to consume enough volume to meet their energy needs, so they add human milk fortifier to give them more bang for the ounce. I mixed up a bottle of 30 kcal/oz for one baby. The techs dispense the milk to the nurses, and everyone checks the medical records on the source and the dispensed milk to be sure that they have the right milk. Some of the babies get as little as 3 mL! (But some of the babies only weigh 500 grams. One in there right now was born at 23 weeks’ gestation. She’s hanging in, but she sure is small.) The nurse brought by one of the babies who is doing really well – it was such a delight to see him, given the sickness of the babies on the floor and the fact that I have spent the week seeing oncology patients.

When it got a little slow in the Nutrition Room, I joined Pat for rounds and listened in to a short talk the attending gave about complications seen in infants of diabetic mothers (google Mermaid Syndrome if you want to see one really rare, serious complication).

We had journal club in the afternoon, during which on of the RDs reviewed dermatological changes associated with micronutrient deficiencies common in patients with alcoholism.

Finally, I ended the day by working up and visiting a couple of oncology patients. I practiced calculating and writing TF recommendations and discussing the pros/cons of different formulations with my preceptor. Among those who can eat, most are on a neutropenic diet (no fresh fruits or vegetables, no uncooked black pepper), which seems like common sense given their compromised immune systems. However, my preceptor told me that this is based mostly on tradition, there isn’t any evidence that a neutropenic diet is any more protective against infection than regular diet. Much of what my RD does with her patients is try to encourage them to eat as much as possible, and it is a shame that they have to avoid foods that they might want (eg, pimento cheese—which has peppers—or chicken salad with celery) because of their neutropenic diet.