Transitioning from fortified milk to EBF'ing

paige0328 · January 2012

Since LO came home from the NICU, we have been fortifying my BM with Neosure to add calories. She's up one pound past her birth weight and has started gaining, on average, a half a pound per week. I'm pumping exclusively (except for one breastfeeding session at night after she's had her bottle - this at the direction of the pedi). If you started feeding with fortified BM and are now exclusively BF'ing, at what point were you allowed to make the transition and eliminate the formula? At this point, I'm worried she will just prefer the bottle altogether because it's easier to eat, and pumping exclusively is exhausting. It takes me 30 minutes to get enough to cover one feed and it's consuming me. BF'ing would be so much easier, but I've been directed to "continue with the feeding routine" for now. I also think the Neosure is causing tummy problems... but that's another story. Thank you for the replies!

Weincraft · January 2012

Your story sounds JUST like mine! My pedi had me staying on the fortified for a while.. and I too think it caused a lot of tummy problems.. and I have yet to find the right formula... would like to continue to give it to her along with BM since I dont produce enough unless i am sleeping with the pump on.

my LO has a problem with BFing where she doesnt put enough into her mouth ~ since she has been on the bottle she only wants to take my nipple, which is painful and also tires her out easily and then she doesnt get enough to eat. I also would like to just BF but im stuck pumping currently.

I feel your pain.

SushiNoMore · January 2012

My son was majorly constipated from the neosure, and it caused horrible diaper rash. We were able to discontinue it very early on - maybe right around his due date? He had been gaining well, so my pediatrician was okay stopping it. Could you suggest maybe stopping it or cutting back, and then restarting it if her weight starts to drop off?

Good luck!

staceylynn1229 · January 2012

My 32 weeker (3lb 6oz birth weight) was in the hospital for 5 weeks and they fortified my bm the whole time. However, when we went home, we did not have to continue fortifying. I, too, was EPing.

gysberger04 · January 2012

Our pedi is following the directions from our NICU, which was to fortify BM with neosure (2 bottles/day) for 6-12 months; we will hear at our NICU follow-up appt. in April (when LO is 6 months old, 4 adjusted) if we need to continue fortifying milk or EBF (I BF other than the 2 bottles/day with neosure). They said that preemie babies need the extra calories to help with weight gain as well as to help with brain development.

haziedaze · January 2012

I should preface this by saying that I'm a bit of a rebel, LO does well at the breast, and I don't have supply issues. If any of those were different, my perspective would be too.

I think the whole fortifying thing is a little voodoo- i.e. NICUs are a little behind the learning curve in the "breast is best" camp. No one really knows how many calories are in BM (preemie moms often make milk that is already more than 20kcal/oz) or how many calories an individual baby really needs.

Our NICU also does the 2 bottles a day thing, so we came home doing that but I hated pumping and DH hated giving "cow milk to our human baby when we had plenty of human milk." I started only BF and then checked weights at my LC's office 2x per week. Maybe it's a coincidence but LO actually started gaining more weight (1lbs/wk) once I stopped the bottles. It may also be that this helped my oversupply get in check so it helped resolve some of my foremilk/hindmilk imbalance issues.

Basically I think you should try to aim for a plan that works for your baby and your family. Certainly preemies need to gain weight well, but I'm not convinced that fortifying bottles is necessarily part of this equation. Talk with your pedi or a trusted LC to make a plan which will likely involve weaning off the fortified bottles (cut 1-2 per week), nursing more (on demand and as often as possible), and checking weights often. GL!

ETA: I started weaning the fortifier at about 39wk adj once we had ditched the nipple shield successfully.

nicu1999 · January 2012

My son was born at 32 weeks and we fortified with NeoSure as well. He definitely had tummy troubles and as soon as we were able to switch to just breast milk, his troubles completely went away. He gained weight so well - between 1/2 to 1 pound per week. Once he was about 10 weeks or so we started only had to do one or two bottles per day - the rest were all breast. My son was able to nurse or drink from a bottle with no problems, and when given a choice, he always chose breast over bottle. I weened him when he was about 10 1/2 months old and that went really smoothly. I was sad about weening, but he was teething and he couldn't resist the temptation to bite me. My son grew amazingly well from the fortified bottles and from exclusively breast feeding this year - today is his first birthday and he's up from 4.1 pounds to 26 pounds! Good luck and keep us posted!

SushiNoMore · January 2012

haziedaze:

I should preface this by saying that I'm a bit of a rebel, LO does well at the breast, and I don't have supply issues. If any of those were different, my perspective would be too.

I think the whole fortifying thing is a little voodoo- i.e. NICUs are a little behind the learning curve in the "breast is best" camp. No one really knows how many calories are in BM (preemie moms often make milk that is already more than 20kcal/oz) or how many calories an individual baby really needs.

Our NICU also does the 2 bottles a day thing, so we came home doing that but I hated pumping and DH hated giving "cow milk to our human baby when we had plenty of human milk." I started only BF and then checked weights at my LC's office 2x per week. Maybe it's a coincidence but LO actually started gaining more weight (1lbs/wk) once I stopped the bottles. It may also be that this helped my oversupply get in check so it helped resolve some of my foremilk/hindmilk imbalance issues.

Basically I think you should try to aim for a plan that works for your baby and your family. Certainly preemies need to gain weight well, but I'm not convinced that fortifying bottles is necessarily part of this equation. Talk with your pedi or a trusted LC to make a plan which will likely involve weaning off the fortified bottles (cut 1-2 per week), nursing more (on demand and as often as possible), and checking weights often. GL!

ETA: I started weaning the fortifier at about 39wk adj once we had ditched the nipple shield successfully.

I kind of agree with all of this, too. Especially the bolded part. I think pedis just want to cover their arses a bit by suggesting fortified bottles. If your baby doesn't gain well, that's one thing. But to just blindly push fortified bottles because of some protocol seems crazy to me. I don't understand why you can't stop the fortifying and then monitor weight to be sure the baby is growing well with just breastmilk.

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