Working In A Formula Room

It has been awhile since I have spoken about my day job here on the blog. As you may recall, I work in a Neonatal Intensive Care Unit (NICU) and I am a pediatric dietitian. I work with newborn babies and I calculate their nutrition needs to help them grow appropriately since most of our patients are born early. Another part of the job, is helping to oversee our Formula Rooms. This is the part of the NICU where all of the feedings are put together/made for our patients in 24 hour batches. We help to schedule, oversee and hire the Formula Room Technicians that work in those mixing rooms. Sometimes the dietitians fill in those shifts as well if we don't have enough techs to fill the spots on a particular weekend. 

This last week I have had the opportunity to work in our Formula Rooms a couple of times. I am always impressed with our system and how we so accurately get all of our babies fed ~ 8 times a day. It is truly a well oiled machine and is so neat to be a part of that. 

I thought it might be neat to address some of the Frequently Asked Questions that I get about our Formula Room/NICU and how nutrition plays a role in that environment. Most people are surprised to learn that there are dietitians in the NICU and that we have a mixing room for feedings. 

Frequently Asked Questions

1. What does a dietitian do in a NICU?
   • This is a great question. The role of a dietitian in a NICU varies, but the main role is to help provide nutrition care to this specialty population. The RD serves as the nutrition expert on the medical team and provides guidance/advice to the neonatologist about  the best feeding recipe for each patient. Each week the RD sees every patient in the NICU and writes up a nutrition note about their plan of care that week. The RD would suggestion what feeding option might be best for that patient, the avenue of administering the feeding, when start vitamins, how feedings might change based on lab values and monitor growth velocity and tweak the nutrition plan as needed. 
2. Do you just mix formula in the Formula Room?
   • No. In our Formula Room we prepare ALL of the feedings for ALL of our patients and they are stored in a refrigerator in that room. The RN will come in and out of the Formula Room to get the feedings and take that aliquot to the bedside and feed the baby. Each patient has their own bin in the refrigerator and their feeding is in that bin for the RN to grab anywhere from 6-8 times per day.
3. How do you feed your patients?
   • In the NICU, since our patients are normally premature, our most common form of administering nutrition is via a feeding tube or via TPN. We prefer to use the GI tract and will try to give feedings via the feeding tube and we work to wean TPN support as soon as possible due to line infection risk and liver damage. Infants do not have their swallow/feeding reflex developed until ~34 weeks gestation and so that would be the point that with cues, we might start some bottle feedings. 
4. Do you feed your patients breast milk? 
   • Yes. Our goal is to use maternal breastmilk whenever possible. That is the gold standard for all of our babies, because it has so many protective properties. Some times there are medical diagnoses that prevent the use of breastmilk, but those cases are limited. Premature babies also need higher calories, more fat and more protein. They are born early and their nutrition needs are higher compared with a term infant. This means that unfortified breastmilk won't meet their nutrition needs so in the NICU we use different formula/fortifier to add to the breastmilk to increase the calories, protein, fat and other vitamins the infant is receiving. We have recipes that we use to mix these feedings and that is the primary role of our formula room technicians. They are the ones that will mix up these recipes for each baby in 24 hours batches and those feedings will be used throughout the day by the nursing staff.
5. How much do you prepare each day in the Formula Room?
   • Our technicians make 24 hour batches for all the babies that we are mixing for that day. Our NICU holds 90 babies and our nursery unit holds an additional 10 babies. There is the potential that we could mix for all 100 babies, but that is normally not the case. It is inevitable that there is a baby or two who are NPO (nothing by mouth). Our average census is ~70-80 patients at a time. 
6. Why do you have technicians mixing feedings compared with nursing staff? 
   • Nursing staff in some hospitals do mix feedings and they have at our hospital in the past. With this creation of a Formula Room space it is more conducive to having one person mixing up feedings compared with each RN mixing their feedings. It decreases the number of people in the room and would decrease risk of errors/infection risk. We work hard to make sure that our technicians are trained well and mix the feedings appropriately. This helps give the RNs more time at the bedside to do what they do best, provide that direct care for our babies. 

Hopefully this has given you a little better idea about what we do in the NICU and how we provide top-notch nutrition care to our patients. We have some of the sickest babies in the state at our hospital and I am so proud of our medical staff for the level of care that we provide each and every day!