The Horrible Very Bad “NPO”

Nil Per Os: A Latin phrase which means, “nothing through the mouth”

Outside of the truly bad things, those three little letters have come to foreshadow more anguish and suffering around our household than most any other.

Don’t feed your baby. Don’t feed your baby.

It’s really hard to get that through the head, and even harder after a few hours of listening to her fuss about it. With an older child, I’d imagine you can explain somewhat, but Zoe only wants one thing at this point, and she just doesn’t understand when she doesn’t get it.

We’re due for Zoe’s new line to be installed today. We spoke to Dr. W and had the actual VP-16 moved back a day to our and her relief, so that she is not getting it right on the heels of the surgery and well into the night. In order to have the surgery though, Zoe has to have her anesthesia, and of course this means that little card appears with the dreaded NPO on it.

We have some confusion as to when the NPO is to start, and a little frustration as a result. Michelle was told initially 12am on the phone, with a surgery scheduled for 12pm. That’s 12 hours without food for a child who eats every 2 hours normally. A little harsh? You would think so. The nurse specifically said no milk or formula, even though the 12am time is typically for solid foods.

The point of confusion is that we were told 4 hours on Monday by the surgeon doing the procedure, and we tend to want to trust that number more.

So to try and resolve it, I call in, explain who I’m calling for, and that I need clarification on the NPO. “How long before the surgery do we need to wait to feed her?” 12am. I explain that Zoe is 3 months old, and immediately the response is “oh, well the NPO is more for solid foods she can have fluids up to five hours before.”

I feel sure that whatever information is available to whoever is making that decision must indicate her age. Surely. If it is, I wish that they would give us the 5 hour number up front.

After a little more back and forth, we clarify that it’s technically 4 hours, but they tack on an extra hour in case they want to move up her surgery, and the NPO is pretty much always set for 12am the day before surgery. Does it matter if it’s an infant? Technically yes, but in practice, no. They put what they put and it’s again up to the parent to push back and get the exact information, lest they suffer through needless additional hours of crying inconsolable baby stress.

Early in our stay at the hospital, for her first Broviac, this same thing happened exactly — one person told us 4 hours but someone else said midnight, we played it safe and went with midnight, and the result was a horrible experience for Zoe and Michelle and I. At that time Zoe’s blood pressure and heart rate were a concern, since she was still fighting back from her initial fever, yet still she was put on a 10-hour NPO crying and amping up her stress all night.

This time, we knew better. Progress!  And, now Zoe and her parents will get to sleep tonight instead of living the horror movie that is an unfed baby.

Update: Zoe is done with surgery, all went well. She was very very hungry by the time of it, and let everyone know.  As feared however, we did not actually get in there until 2pm.

I completely understand the difficulty in lining up multiple departments at one time to get the Surgeon, Anesthesiologist and Oncology NP in at the same time, but it feels like there must be a way that doesn’t involve infants going unfed for 7-12 hours routinely. At the very least making sure to distinguish between solid fed and breast/formula fed children seems like it would be a good idea.

3 thoughts on “The Horrible Very Bad “NPO”

  1. So happy things went well for Zoe. It does seem as though they could not delay a surgery for an infant who has not eaten as they do not understand why they are not being fed.

    Thanks for the update and we continue to pray for you all!!

    Love to you,


  2. Glad she is doing OK. It sounds as if the Drs. need to coordinate a little so that everyone is on the same page in her procedures. I’m sure that she is starved after waiting so long to be fed and I’m sure she protests loudly.
    You all are in our prayers. Grandmother & John

  3. Evan,

    Once Zoe is totally well and if you were willing, you should consider asking her doctors if they could use your blog for training their med students/residents at Baptist. You’re giving such an informed, well-written, and well-considered account of your and your family’s experience that it would hard for medical people to dismiss it, as they might do with a standard “anecdotal” report.

    This type of NPO issue occurs very often and, believe me, it is upsetting to nurses when it occurs, especially with babies/kids, people with diabetes, people who are already undernourished and dehydrated, and on and on. I know WHY it happens [lots of understandable reasons and a few not so good reasons] and at the same time I know that it can be a terrible stressor on patients and families.

    I’m sure Zoe is deeply reassured once she can back get to her food source.:). And next time I visit Michelle, I”m going to bring her the healthiest most nutrient-rich food I can find!

    You are both continuing to do a remarkable job at this time in your family’s life. Zoe will definitely make it through this – look what’s she’s accomplished already. She’s a very resilient girl!

    Love, Mara

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s