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Formula For Growth: She Helps Those Tiny NICU Babies Flourish

Blog Formula For Growth: She Helps Those Tiny NICU Babies Flourish

Wendy Cruse is a dietitian in the neonatal intensive care unit. Figuring out the perfect nutritional formula for each baby is a complicated and delicate balance.


When it comes right down to it, it’s nothing more than a few drops. A tiny, tiny amount of milk.

Two millimeters. One-fifteenth of an ounce.

That’s all the milk a baby, who comes to the neonatal intensive care unit born weighing just a pound, will be given. It’s all their tiny bodies can handle. It’s all they need.

Two milliliters given every three hours throughout the day. In a 24-hour period, that is just more than half of an ounce.

Sounds so miniscule, such a micro amount.

But as those babies take that in, little by little, Wendy Cruse watches them grow – and grow and grow.

It’s Cruse’s job as a NICU dietitian at Riley Hospital for Children at IU Health to figure out the perfect nutritional formula for each baby. It’s a complicated and delicate balance.

“They come in and they are teeny tiny,” she says. “It’s so rewarding to see them really flourish.”

We sat down with Cruse, who has been at Riley 27 years, to learn more about her career.

How is such a tiny baby fed? “It goes through a nasal gastric tube. Usually, they will be given a pacifier during that time so the baby knows, ‘I’m sucking and now I’m getting full.’”

How, generally, does feeding progress from there? “They’ll get more and more volume, so the goal in the little ones is to get off the IV nutrition within 7 to 10 days and get onto full feedings. That might even be up to 15 milliliters every three hours. As they grow and grow and are getting close to term, it may be all the way up to 50 or 60 milliliters, so up to two ounces. But it takes a long, long time to get there.”

Describe what a NICU dietitian does: “What we do in the NICU is we monitor growth and nutrition status and then we help with the formula recipes, choosing the right infant formula, helping with IV nutrition. Some of the preemies can’t be fed. Then we monitor labs, figure out how much protein, dextrose, lipids, electrolytes, trace metals and vitamins they need. You monitor, do they need vitamin D or zinc to optimize wound healing and growth? Or, sometimes, they just need more sodium to grow better.”

Each day on rounds: “You listen to the medical side, what the bedside nurses say, how the baby is today. The bedside nurse might be talking about stooling or poor wound healing or a sore bottom from all the stooling or some problem like that. Or the physician might say, ‘Oh, they are really fluid overloaded and that’s not their real weight.’ And we have to decide on what weight they really are to make all these calculations.”

Going home: “We look at growth, nutrition status and then when they’re ready to go home, we talk with families about how to mix this formula when they go home. Normally, because of their medical history, babies don’t go home on just standard formula or standard breast milk. We might have to fortify the breast milk. Or we might have to work on getting a higher calorie level for them. They’ve had a really rocky period. It’s been hard to nourish them, so we have to still catch up.”

More With Cruse

Personal: Cruse and her husband, Paul, have three children. In her free time, she likes to read and cook – especially healthy soups and salads.

Education: Cruse has a bachelor’s degree in nutrition and is a certified registered dietitian. In 1990, she came to Riley for a neonatal/pediatric nutrition fellowship and later earned a Master of Medical Science degree from the IU School of Medicine. She also continues her education each year as new literature and processes come out.

Before the NICU: She spent several years as a pediatric clinical dietitian specialist in different departments, including the burn unit, surgery and covering for the cystic fibrosis and hematology and oncology units. She is still a dietitian in Riley’s bowel rehab clinic.

Accolades: Just this month, Cruse was awarded the 2017 Rickard Leadership in Pediatric Nutrition Award by the IU School of Health and Rehabilitation Sciences at IUPUI. Her leadership accomplishments as an author, speaker and a clinical dietitian in the areas of neonatal intensive care, organ transplantation and short bowel syndrome have left a national mark. “Wendy is a leader and master clinician who is sought locally, regionally and nationally by the elite -- surgeons, physicians and nutritionists -- for her expertise, primarily because of the good nutritional and neurocognitive outcomes of extremely high-risk infants and children that she treats," Karyl Rickard, the professor emerita who established the annual award said of Cruse.

-- By Dana Benbow, Senior Journalist at IU Health.

   Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow.

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