Question:

I am looking for information regarding how oral care is performed with infants who are no longer being provided with breast milk (donor or MOM) which in our Level III NICU is usually after 34 weeks PMA if no longer available from mother AND not yet PO feeding.  I’ve seen some facilities using sterile water and some even formula via oral swab, but looking to see what is happening out there!  Thanks.

Catherine’s Answer:

NICUs typically have policies and procedures specific to oral care administration that the nursing team follows because application to the inside of NICU infants’ mouth as oral care is considered immune therapy. Colostrum and early MOM or DBM are high in immunologic, anti-infective and anti-inflammatory factors. And we recognize, as therapists, its potential benefit for the neonate’s oral-sensory processing. Its sweet taste can provide a positive oral experience and perhaps entertain early learning; some researchers wonder if, when it is offered in a developmentally supportive way, the experiences may support sensory-motor learning, and the laying down of pathways in the brain to be recruited later.

There are options built into the P & P’s to accommodate infants who are intubated or have co-morbidities that require an adjusted pathway, and typically that also includes approved optional fluids for that NICU. When no MOM or DBM is available, some protocols I have seen then utilize sterile water. It, however, lacks the immunologic, anti-infective and anti-inflammatory properties of MOM or DBM, and has no “sensory load” for the oral-sensory environment, but neonatologists have cited its sterile nature as a benefit which is part of the “risk-benefit” paradigm that is understandably paramount in the NICU.

Perhaps talk with your neonatal nursing and neonatology colleagues in your NICU — their experience and clinical wisdom is amazing I have found—-and do a lit search — there is so much out there — to gather information you are seeking. Utilize this as an opportunity for cross-fertilization of knowledge about oral cares, partnering for a more developmentally-supportive approach if that might be an opportunity, and further-building of those relationships in your NICU that, as you know, create an amazing environment in which we can be lifelong learners.