Want to be a NICU dietitian??

UMD interns are fortunate enough to be able to spend two weeks at Children's National Medical Center (CNMC) in DC. A few months ago, each intern had the opportunity to choose a team of dietitians to rotate with each week.There were various options in both the inpatient and outpatient settings, working with preterm infants to early-teens. I choose to spend a week in the neonatal intensive care unit (NICU) and the second week with the intestinal rehab dietitian.

I have just finished my first week at CNMC with the NICU dietitians. I will admit, the night before my first day I did not sleep much from nervousness and anxiety. I did not have a clue how I was going to react to seeing such critically-ill babies. Even though I had prepared beforehand and completed all study guides and homework assignments that were assigned, I still felt overwhelmed by infant nutrition and thought I was way in over my head. Once arriving to the NICU and meeting the dietitians, we jumped right into rounds and the nerves were gone immediately. It was all exciting, fast-paced, and interesting. I felt that two hours of rounds were not enough, I wanted to keep learning about all the cases and of course look at all the cute babies. 

But I must say, sick babies are not for everyone. These babies may have life-long complications, have gone through multiple surgeries at only a few days old, and could be spending months in the unit before being able to go home to their family for the first time.

(image taken from Google images)

Realizations I made when working in the NICU:
* Fluid is so important! It is closely measured and monitored.
* Most everything is measured per weight of infant in kg. For example 100mL/kg/day
* Neonatal nutrition is heavily reliant on parenteral nutrition. CNMC NICU dietitians have the ability to adjust PN components and values. Not all dietitians in facilities are able to do that, it is usually pharmacy who compounds PN.
* Hospital stays can be months long. One of the dietitians started at CNMC in July around the same time a NICU baby was born. That baby was not discharged until October!
* Formula? Breast milk? Donor milk? It's a whole different way of thinking. Its not food, like we are used to dealing with.
* The babies can't talk to you! You might think "well duh" but coming from a clinical rotation in the adult population where if you have a question or want to know how your patient is feeling you could just ask. With babies you can't and it just hadn't dawned on me. Instead the babies may cry or make other noises that can tell you something. There are also times where baby's parents are available at rounds but they are usually just learning about their baby like we are! The only time a dietitian will interact with the parents is to discuss or educate the parents on feeding.
* Labs and growth measurements are usually documented daily. A great way to be able to trend how the baby is doing.

(A poster created by the nursing educator providing education for the NICU nurses about the importance of nutrition in growth and development) 

What I loved about working in the NICU is what an important role dietitians play. These infants need nutrition within 24 hours of birth, and the doctors, nurses, parents, and the babies rely on the dietitians to fulfill that requirement.