Preemie & BF

bhdoucette · December 2013

My friend delivered her baby at 36 weeks, 5 lbs 1oz. Her LO is about a week old. In the hospital, she was able to BF right away as baby did better than anticipated (body temp, breathing, etc). LO's sugars dropped so she was told to supplement 0.5-1 oz after each feed, waking LO to feed every 3 hours. On Thursday she began weaning off the supplements, as per the previous advice. On Friday, LO was weighed and gained 2oz since Monday. She was told to feed one side, pump the other and feed LO the pumped milk.

I'm just wondering if my friend should seek a second opinion re the pumping. She's tired due to medical complications, and it just seems like a lot to add 20-30 minutes to each feed. Plus, I was under the impression that 0.5-1oz per day was normal weight gain for a full-term baby, nevermind a preemie.

Edit: grammar

slh6363 · December 2013

My LO was a preemie at 35 weeks and I was given similar advice. But part of the reason was I had low supply and LO would get tired and give up at breast so wanted to make sure he was getting enough calories since he was a preemie. However, I believe the bottle feeding early led to my EPing. LO became not interested in nursing...so if she is determined to nurse I would say try to avoid it...maybe wait it out and see how the weight gain continues. My doctor wanted about 1 oz per day gain.

bhdoucette · December 2013

Thanks for your replies, ladies.

I've tried to nudge her in the direction of an IBCLC, but as she's received the advice from a midwife, she's hesitant. And I don't want to push too hard as she's finding the transition a little tougher than she thought.

She wasn't pumping when she was supplementing. When she began attempting to wean off the supplements, LO started feeding longer and one night woke every hour to feed, which are both positive signs. I agree though, her supply probably needs to increase.

I'll mention the extra feeding during the day. I'm just not sure why she was advised to pump vs keeping baby at the breast. Pumping with a newborn is a hassle.

ETA: LO feeds for 25-45 minutes, which seems normal to me. I suggested a weighed feeding, too.

PurpleIris30 · December 2013

Was she instructed to pump so that the breast milk could be mixed with extra calorie supplementation? Or just to top off a breast feeding session with a bottle? Preemies are burning more calories than newborns to breathe, eat, maintain their temps and grow, so the extra calories and bottle feedings are normal to help them catch up and gain weight. (It's less work for a preemie to drink by bottle.)

Even after my girls started breast feeding in the nicu, we still offered a bottle afterwards since they tired so easily breast feeding and they would consistently take more by bottle.

My girls were born 2 months early and had extended nicu stays. This all sounds very normal to me, but if she has questions, she should ask the neonatologists or someone familiar with preemie needs. Fwiw, my girls are now exclusively breastfed, but it's all about making sure that preemies get enough calories in the beginning.

bhdoucette · December 2013

She's only pumping to top off a feeding. Nothing additional is added. And she isn't seeing any sort of specialist, just her midwife and family doc. They've been at home since a few days after LO's arrival. That's how well LO appears to be doing. There wasn't even a brief NICU stay. Thanks for the perspective of a preemie mom.

I want to offer good advice as she's a FTM, but I don't want to suggest anything that wouldn't be appropriate for a 36 weeker.

PurpleIris30 · December 2013

Sounds to me like her baby is doing fantastic for 36 weeks. It's stressful to have a preemie on top of being a FTM, so make sure to be encouraging of how well she's doing, too.

It sounds like your only concern is that she shouldn't have to pump the other side and should just be able to breastfeed? If she's physically up to pumping a bit so she can offer extra in a bottle, I don't think there's any harm. It can also help increase her supply, which mat be another concern.

Remember that preemies don't have the same strength and stamina as a typical newborn, and often tire easily by breast. My girls were not able to take every feed entirely at breast by 36 weeks. The baby is gaining on the lower end of normal, so I'm sure the midwife and doctors have suggested topping off by bottle to make sure the baby is getting full at every feed and not just wearing out. So long as breast is offered first and baby feeds as long as it is able to by breast, then offering 15 ml or so by bottle is very normal. Preemies also need uninterrupted sleep, so we were also told to wake every 3 hours during the day (of course feed more often than that if awake and indicating hunger). Because it's a strength and stamina issue, waking every 2 hours isn't always the solution to get preemies to eat more.

At 36 weeks my girls weren't doing nearly that well breast feeding, and I was pumping every 3 hours in addition to offering breast to two babies. I was worried about the long-term impact to EBF by topping off with a bottle, but eventually they got strong enough to fill up by breast and would refuse the bottle. I also got better at judging how much they had eaten at the breast.

Good luck to your friend!

bhdoucette · December 2013

Thank you so much! You've been extremely helpful. I really appreciate your insight and will be sure to pass it along.

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