formula supplementation required?

the other day one of the nurses told me that the girls will be sent home on two bottles of formula a day (enfacare if that matters).  They were born at 31 w (currently 35+4) and have been gettjng breastmilk from the beginning.  i make enough and they also seem like they are getting the hang of bfing. They have recently been getting hmf with their bottles and the other day they added vitamins b/c their hematocrits were on the low side.  I didn't ask what the rationale was for two daily bottles ....but was curious as to if that is standard for preemies or not.  Fwiw, i don't think they will be coming home soon, so i may be jumping the gun a bit to wonder. 

Re: formula supplementation required?

  • I would definitely question. We fortified my breast milk with Neosure for extra calories vs giving straight formula bottles.
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  • They suggested that for my LO upon discharge to make sure she was getting enough calories...but I decided to not do that and stick to exclusively BFing.  LO has never had a weight gaining problem so my pedi did not see a problem with my approach.  But you will want to discuss your own personal preferences with your NICU team and your pedi :)
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  • image Missa_g:
    I would definitely question. We fortified my breast milk with Neosure for extra calories vs giving straight formula bottles.

    We're doing this, as well, and this will be the same thing we do going home, as well.
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  • I would ask to make sure it is really necessary.  We were never told to supplement with formula.  I didn't start adding formula to her diet until DD was eating more than I was producing.  We did have to give vitamin & iron drops though.
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  • image Missa_g:
    I would definitely question. We fortified my breast milk with Neosure for extra calories vs giving straight formula bottles.

    This! And now were ebf with the exception of a splash of bm with his caffiene in a bottle once per day.  My dr said if I were to give bottles of bm no need to do the neosure because he is gaining weight.

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  • thank you!  i will definitely be questioning it if they discharge us with those orders then.  i just did  not know if it was standard protocol or not.   
  • My DD was born at 31 weeks also. She came home at 35 weeks and I EBF during the day and we give her 4 bottles from 6PM to about 6AM with breast milk and a teaspoon of Enfacare. You do not need to giver her straight formula, you can add a bit of the enfacare right to your own breast milk. We do it for extra calories and the pedi wants us to continue until she gets bigger. She went home only 4lbs 8 oz. She also had HMF in my breast milk at the hospital and then we switched to Enfacare once we knew that she would be going home soon.
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  • I agree with the others to ask and see if it's really necessary.  If they're having weight gain issues, you could always use the formula to fortify your BM.
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  • Neosure has extra calcium and phosphorus.  Preemies bones don't officy completely because they are born too early.  So, it is recommended.  HOWEVER, you can add neosure to your bm.  It is easy to do and you have to add very little. 

    And, about a month or two after their due dates talk to your doctor again.  

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  • image Missa_g:
    I would definitely question. We fortified my breast milk with Neosure for extra calories vs giving straight formula bottles.

     We did this too. Mine were too small that he doctor did not want them to try bf because they would use too many calories. They also had to have the formula added for extra calories. 

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  • I wish I hadn't supplemented.  I had my DD at 31 weeks 5 days, and she was discharged a month later -- sent home with formula (1 tsp to 3 oz of BM for every bottle).  The problem was, I was trying to BF her.  In short, all of those bottles mixed with some formula totally ruined my BF attempts.  We stopped giving her the formula a few weeks ago and she's still hooked on bottles, but getting a little better at BF.  In short -- always challenge Dr's recommendations if you are planning to EBF, because getting them from a bottle to breast is really hard if they get too many bottles a day...good luck! :)
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  • There was an article in Pediatrics, the AAP's journal, in 2011 about supplementing. It was an observational study with one group getting a standard amount of supplementing and the other on BM or formula. All groups had the same amount of weight gain by a year. Supplementing may help kick start weight gain, but if it doesn't matter at a year... We stopped supplementing when my friend who's a pedi and IBCLC gave us the article. Ds2 is already almost 13lb, so it didn't matter anyway.
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  • My smaller twin came home on half BM and half High Cal formula. The hospital sent me home with three 6 bottle cases of the formula. When that was done, I made my BM high cal by taking 9oz of BM and adding a scoop of powder formula to it (recipe calls for 1tsp to 3oz of BM which works out to 1 scoop per 9oz bottle). She would have been sent home on fortified BM but she hated the taste and refused to drink it.

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