New preemie nephew - help please

[She's A Goddess]

My nephew was born Tuesday afternoon at 35w4d. He weighed 6lb6oz and was 19
1/4 inches long and is perfectly healthy, just a bit early. Due to his
prematurity they put mom on a pump after every feed regimen and supplement
baby after every feed. I felt dubious about this and called my much trusted
LC. After talking to her I felt better about it although not sure that he
needed as much extra as SIL's hospital was telling her. To avoid formula I
supplied them with 8 ounces of my milk, hoping that would get them through
to her milk coming in and her being able to pump enough for his supplemental
feeds. 21 hours later they are down to an ounce and a half. My LC is off
today so I can't get in touch with her. Her backup is supposed to call me
back. My issue is this - how necessary are the supplemental feeds? My LC
thought that baby should get whatever mom pumped. The hospital wants her to
feed 15-20 cc's. Apparently, he is sometimes "taking" as much as 30-35
cc's. My thoughts are that a term baby would only get colostrum and
wouldn't starve for it. I can understand the need for some extra calories,
but 30-35 cc's seems to be taking it awfully far. I want to advice them to
give him the extra 15 and then wait until he acts hungry again, nurse, pump
repeat. I'm an hour plus away and am going to have a hard time getting them
more milk. Thoughts?

Thanks,

Rhiannon - sorry for the rattled post the two year old is calling
Mom to M. Girl and O. Boy

[Denise]

"She's A Goddess" > wrote in message
news:YbAjb.147208$%h1.146537@sccrnsc02...
> My nephew was born Tuesday afternoon at 35w4d. He weighed 6lb6oz and was
19
> 1/4 inches long and is perfectly healthy, just a bit early. Due to his
> prematurity they put mom on a pump after every feed regimen and supplement
> baby after every feed. I felt dubious about this and called my much
trusted
> LC. After talking to her I felt better about it although not sure that he
> needed as much extra as SIL's hospital was telling her. To avoid formula
I
> supplied them with 8 ounces of my milk, hoping that would get them through
> to her milk coming in and her being able to pump enough for his
supplemental
> feeds. 21 hours later they are down to an ounce and a half. My LC is off
> today so I can't get in touch with her. Her backup is supposed to call me
> back. My issue is this - how necessary are the supplemental feeds? My LC
> thought that baby should get whatever mom pumped. The hospital wants her
to
> feed 15-20 cc's. Apparently, he is sometimes "taking" as much as 30-35
> cc's. My thoughts are that a term baby would only get colostrum and
> wouldn't starve for it. I can understand the need for some extra
calories,
> but 30-35 cc's seems to be taking it awfully far. I want to advice them
to
> give him the extra 15 and then wait until he acts hungry again, nurse,
pump
> repeat. I'm an hour plus away and am going to have a hard time getting
them
> more milk. Thoughts?
>
> Thanks,
>
> Rhiannon - sorry for the rattled post the two year old is calling
> Mom to M. Girl and O. Boy
>
>

That's a super birth weight. Why are they supplementing at all? Baby 3 was
just shy of 5 pounds, and 5 pounds is what was needed to be discharged from
the hospital. They never required me to supplement feedings as long as she
was nursing on her own. And they did let me nurse, not pump. I would fight
the supplemental feeds unless the baby had other health issues.




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[Clisby]

Denise wrote:
> "She's A Goddess" > wrote in message
> news:YbAjb.147208$%h1.146537@sccrnsc02...
>
>>My nephew was born Tuesday afternoon at 35w4d. He weighed 6lb6oz and was
>
> 19
>
>>1/4 inches long and is perfectly healthy, just a bit early. Due to his
>>prematurity they put mom on a pump after every feed regimen and supplement
>>baby after every feed. I felt dubious about this and called my much
>
> trusted
>
>>LC. After talking to her I felt better about it although not sure that he
>>needed as much extra as SIL's hospital was telling her. To avoid formula
>
> I
>
>>supplied them with 8 ounces of my milk, hoping that would get them through
>>to her milk coming in and her being able to pump enough for his
>
> supplemental
>
>>feeds. 21 hours later they are down to an ounce and a half. My LC is off
>>today so I can't get in touch with her. Her backup is supposed to call me
>>back. My issue is this - how necessary are the supplemental feeds? My LC
>>thought that baby should get whatever mom pumped. The hospital wants her
>
> to
>
>>feed 15-20 cc's. Apparently, he is sometimes "taking" as much as 30-35
>>cc's. My thoughts are that a term baby would only get colostrum and
>>wouldn't starve for it. I can understand the need for some extra
>
> calories,
>
>>but 30-35 cc's seems to be taking it awfully far. I want to advice them
>
> to
>
>>give him the extra 15 and then wait until he acts hungry again, nurse,
>
> pump
>
>>repeat. I'm an hour plus away and am going to have a hard time getting
>
> them
>
>>more milk. Thoughts?
>>
>>Thanks,
>>
>>Rhiannon - sorry for the rattled post the two year old is calling
>>Mom to M. Girl and O. Boy
>>
>>
>
>
> That's a super birth weight. Why are they supplementing at all? Baby 3 was
> just shy of 5 pounds, and 5 pounds is what was needed to be discharged from
> the hospital. They never required me to supplement feedings as long as she
> was nursing on her own. And they did let me nurse, not pump. I would fight
> the supplemental feeds unless the baby had other health issues.
>
>

That's exactly what I was wondering. That's just 2 oz. less than my
full-term son weighed at birth, and nobody made any noises about
supplementing. Or is there some reason a preemie needs extra calories
right from the start, even if he's born at really good weight?

Clisby
(wondering how big this child would have been if he had gone full-term)

[She's A Goddess]

"Clisby" > wrote in message
...

>
> That's exactly what I was wondering. That's just 2 oz. less than my
> full-term son weighed at birth, and nobody made any noises about
> supplementing. Or is there some reason a preemie needs extra calories
> right from the start, even if he's born at really good weight?

Yup according to my LC (again, much trusted) preemies have extra issues even
if they're born at a "good" weight. If I'm reciting this all correctly, the
baby doesn't have the necessary brown fat stores that a full term baby does.
They do not want baby to stay latched on constantly to meet his demands
because it will take more calories than he will get. Thus he needs
supplementation to get calories that he might otherwise get nursing without
having to do the amount of work of nursing and possibly expending more than
he's getting. And mom needs to then pump to try and up her supply the way
the baby would have had he nursed as much as "normal".

> Clisby
> (wondering how big this child would have been if he had gone full-term)

Well, first there is some question as to whether he is really a 35 weeker.
There is some chance that she was due two weeks earlier (first u/s said
10/31 was due date, second said 11/14). If thats the case all of this is
unnecessary. Otherwise, possibly as big or bigger than my lovely 9lb6oz'er.

Rhiannon
Mom to M. Girl and O. Boy

[Alison]

"She's A Goddess" > wrote in message
news:E4Bjb.147686$%h1.146397@sccrnsc02...
>
> "Clisby" > wrote in message
> ...
>
> >
> > That's exactly what I was wondering. That's just 2 oz. less than my
> > full-term son weighed at birth, and nobody made any noises about
> > supplementing. Or is there some reason a preemie needs extra calories
> > right from the start, even if he's born at really good weight?
>
> Yup according to my LC (again, much trusted) preemies have extra issues
even
> if they're born at a "good" weight. If I'm reciting this all correctly,
the
> baby doesn't have the necessary brown fat stores that a full term baby
does.
> They do not want baby to stay latched on constantly to meet his demands
> because it will take more calories than he will get. Thus he needs
> supplementation to get calories that he might otherwise get nursing
without
> having to do the amount of work of nursing and possibly expending more
than
> he's getting. And mom needs to then pump to try and up her supply the way
> the baby would have had he nursed as much as "normal".
>
<snip>
Gosh I'm amazed at this. Our son was born at 34 weeks exact. He was 5lb9oz.
He had two days of intravenous fluids then they said that they'd like to
start giving him breast milk via his tube. So I began the 3hourly pumping
sessions (bearing in mind that I'd had two days where no-one had mentioned
milk/pumps etc and it hadn't crossed my mind cos I was still shell-shocked
but not physically - it was a VB with no rips) and it was a good 48hrs
before I could even cover the bottom of a 50ml pot - hard work and many
tears shed before supply got established. Then he got 10mls every 4 hrs
building up to 50mls every 4 hrs over four days then onto the breast for
feeds (we'd been practising but his suckability wasn't in yet). Never not
once was supplementing mentioned. Yes they said about brown fat but just
that this meant he would still need to be clothed like a winter baby despite
it being one of the hottest summers the UK has seen.

But then I'm not a pediatrician nor a LC ......

--Alison

[Di]

On Thu, 16 Oct 2003 17:03:52 GMT, "She's A Goddess"
> wrote:

>My nephew was born Tuesday afternoon at 35w4d. He weighed 6lb6oz and was 19
>1/4 inches long and is perfectly healthy, just a bit early.

Congrats on your new little nephew. That is a good weight DD was 34w
5d and 5lb even.

>Due to his
>prematurity they put mom on a pump after every feed regimen and supplement
>baby after every feed.

Is he sucking at all? It took 2 weeks before DD was able to suck (she
was on tube feeds before that). During that time I had to pump. Once
DD was able to suck I did have to postfeed pump while she was still in
hospital (total of 4 weeks).

> My issue is this - how necessary are the supplemental feeds?

I think it is more the seeing how much the baby is getting v's how
long it is taking.

> The hospital wants her to
>feed 15-20 cc's.

Is this how much she is b/fing him? How are they working this out?

> Apparently, he is sometimes "taking" as much as 30-35
>cc's. My thoughts are that a term baby would only get colostrum and
>wouldn't starve for it. I can understand the need for some extra calories,
>but 30-35 cc's seems to be taking it awfully far. I want to advice them to
>give him the extra 15 and then wait until he acts hungry again, nurse, pump
>repeat. I'm an hour plus away and am going to have a hard time getting them
>more milk. Thoughts?

Some preemies don't act hungry, I know DD didn't until she had been
home at least a week or more. As such the hospital likes to feed and a
fixed time scale (starting a every hour), I did however see them
allowing food earlier if the preemie was showing signs of being
hungry. There is a calculation that is used to work out how much milk
a preemie should be getting. Do you know how often he is getting
30-35cc's?

I do wish you and your SIL all the best.

Di

[Dawn Lawson]

She's A Goddess wrote:
>
> Well, first there is some question as to whether he is really a 35 weeker.
> There is some chance that she was due two weeks earlier (first u/s said
> 10/31 was due date, second said 11/14). If thats the case all of this is
> unnecessary.

When I was doing some literature research about u/s to ward off the
pressure to have one done (other than the RE required one at 7wks to
check for multiples), I read several times that the earlier u/s are more
accurate than later ones for due date determination.
I've no idea if I could track it down again to find out what encompassed
"earlier" but I'd be tempted to consider this guy fully cooked unless
there are other indicators that he isn't. Weight and questionable due
date wouldnt be enough for me, personally.

JMO, YMMV
Dawn

[[email protected]]

"Alison" .uk> wrote in message >...

> <snip>
> Gosh I'm amazed at this. Our son was born at 34 weeks exact. He was 5lb9oz.
> He had two days of intravenous fluids then they said that they'd like to
> start giving him breast milk via his tube. So I began the 3hourly pumping
> sessions (bearing in mind that I'd had two days where no-one had mentioned
> milk/pumps etc and it hadn't crossed my mind cos I was still shell-shocked
> but not physically - it was a VB with no rips) and it was a good 48hrs
> before I could even cover the bottom of a 50ml pot - hard work and many
> tears shed before supply got established. Then he got 10mls every 4 hrs
> building up to 50mls every 4 hrs over four days then onto the breast for
> feeds (we'd been practising but his suckability wasn't in yet). Never not
> once was supplementing mentioned. Yes they said about brown fat but just
> that this meant he would still need to be clothed like a winter baby despite
> it being one of the hottest summers the UK has seen.

My DS was born at 34 weeks 1 day, 4lb14 oz, IV fluids, then whatever I
could get him to take from breast followed by whatever I could pump
and get him to take from a bottle. I cannot pump worth beans -- he
never got over 25 mls that way while in the NICU. (He was
supplemented once, 20 mls formula right before discharge by an overly
enthusiastic nurse while I was just down the hall talking to the
IBCLC...) At discharge six days later he was nipple-confused, up to
5lb3oz, and I was to "treat him like a normal baby". I dropped the
pumping and bottles three days later IIRC when I got two good latches
in a row, as I wanted to stop the nipple-confused behaviors, and just
breastfed on demand. He was up to 5lbs12oz at his checkup ten days
after discharge.

My experience, then, suggests that it isn't always necessary to follow
the protocol she's been recommended.

--
C, mama to 11 month old nursling

[She's A Goddess]

> wrote in message
m...
> My DS was born at 34 weeks 1 day, 4lb14 oz, IV fluids, then whatever I
> could get him to take from breast followed by whatever I could pump
> and get him to take from a bottle. I cannot pump worth beans -- he
> never got over 25 mls that way while in the NICU. (He was
> supplemented once, 20 mls formula right before discharge by an overly
> enthusiastic nurse while I was just down the hall talking to the
> IBCLC...) At discharge six days later he was nipple-confused, up to
> 5lb3oz, and I was to "treat him like a normal baby". I dropped the
> pumping and bottles three days later IIRC when I got two good latches
> in a row, as I wanted to stop the nipple-confused behaviors, and just
> breastfed on demand. He was up to 5lbs12oz at his checkup ten days
> after discharge.
>
> My experience, then, suggests that it isn't always necessary to follow
> the protocol she's been recommended.

Thanks for the data point. This is really encouraging. Right now we're
seeing all the LC's possible and listening to their advice and I'm compiling
what I know with all of that and helping them to make the right decisions.
My B and SIL are good kids, and will I think make good parents but
unfortunately they are a bit naieve and don't have access to a lot of good
information.

--
Rhiannon
Mom to M. Girl and O. Boy

[She's A Goddess]

"Di " > wrote in message
...

>
> Is he sucking at all?

He is. He slurps a bottle right down, and apparently does good with mom
sometimes. However, other times he's awfully sleepy and my take is that
they aren't persistent enough in waking him up so instead let him have a
bottle.


> Is this how much she is b/fing him? How are they working this out?

Sorry. They're nursing (if all goes well) for about 7 - 10 minutes, one
side only, and then giving the bottle. If he doesn't nurse he's taking
higher volume bottles.

> Some preemies don't act hungry, I know DD didn't until she had been
> home at least a week or more. As such the hospital likes to feed and a
> fixed time scale (starting a every hour), I did however see them
> allowing food earlier if the preemie was showing signs of being
> hungry. There is a calculation that is used to work out how much milk
> a preemie should be getting. Do you know how often he is getting
> 30-35cc's?

He's taking 20-25 cc's after nursing every 2 1/2 to 3 hours, or 35 cc's if
they failed in getting him to latch and suck. But Mom's milk is in today!
Yay! Now I've just got to figure out the good middle road for how long she
should pump - both each session, and for the long term. Right now I've got
her pumping until the milk stops flowing and she's getting about an ounce
each side still going up. For the long term I'm telling her to take it a
day at a time but I've got another call into my LC to get her advice.

Thanks.

--
Rhiannon
Mom to M. Girl and O. Boy

[[email protected]]

"She's A Goddess" > wrote in message >...
> "Di " > wrote in message
> ...
>
> >
> > Is he sucking at all?
>
> He is. He slurps a bottle right down, and apparently does good with mom
> sometimes. However, other times he's awfully sleepy and my take is that
> they aren't persistent enough in waking him up so instead let him have a
> bottle.

Is he jaundiced at all? DS was jaundiced and it made him sleepier
than normal. He was actually jaundiced until he was 2.5 months old
(the unimportant breastfeeding jaundice kind) and mostly slept and ate
until early January...

--
C, mama to reeeally fast crawling 11 month old nursling
and five terrified cats ("Kiky! Eeeeaaaaaahhhh!!!!")

[Di]

On Fri, 17 Oct 2003 20:47:57 GMT, "She's A Goddess"
> wrote:

>
>"Di " > wrote in message
...
>
>>
>> Is he sucking at all?
>
>He is. He slurps a bottle right down, and apparently does good with mom
>sometimes. However, other times he's awfully sleepy and my take is that
>they aren't persistent enough in waking him up so instead let him have a
>bottle.

Sleepy is to be expected - but I would agree with you - they need to
make him wake up and take the breast :). A nipple shield may be an
idea for a few days as well. Also check what nipple size they are
using on the bottle - as you know he should only be having the slowest
possible size.

>
>
>> Is this how much she is b/fing him? How are they working this out?
>
>Sorry. They're nursing (if all goes well) for about 7 - 10 minutes, one
>side only, and then giving the bottle. If he doesn't nurse he's taking
>higher volume bottles.

Mmmm I would try and see if she can get a longer time on the breast.
Do you know if it is a case of "time up, get him off and give bottle"
or "he is starting to slip off, lets finish with a bottle"?

>He's taking 20-25 cc's after nursing every 2 1/2 to 3 hours, or 35 cc's if
>they failed in getting him to latch and suck. But Mom's milk is in today!
>Yay! Now I've just got to figure out the good middle road for how long she
>should pump - both each session, and for the long term. Right now I've got
>her pumping until the milk stops flowing and she's getting about an ounce
>each side still going up. For the long term I'm telling her to take it a
>day at a time but I've got another call into my LC to get her advice.

Yayay - great to hear that Mum's milk is in. I needed to pump at least
30 mins (this triggered multiple letdowns) each side.

Sounds like a good idea for the long term. Remember to tell her she is
doing great as well :). (((hugs))) to you, SIL and your nephew.

Di

[She's A Goddess]

"Di " > wrote in message
...
> On Fri, 17 Oct 2003 20:47:57 GMT, "She's A Goddess"
> > wrote:
>
> Sleepy is to be expected - but I would agree with you - they need to
> make him wake up and take the breast :). A nipple shield may be an
> idea for a few days as well. Also check what nipple size they are
> using on the bottle - as you know he should only be having the slowest
> possible size.

Yep. We had a great LC appointment on Saturday where the nipple shield was
introduced, mom and baby got a *good* latch and nurse session and mom got
some confidence. So since then he's only had a few bottles in the middle of
the nights when they are both to sleepy to get it correct. I've convinced
her that will have to stop soon but one step at a time, right? They are only
using Avent bottles with newborn nipples.

> Mmmm I would try and see if she can get a longer time on the breast.
> Do you know if it is a case of "time up, get him off and give bottle"
> or "he is starting to slip off, lets finish with a bottle"?

It was a bit of both, but at the appointment on Saturday I got the LC to
endorse the idea that there is no time limit. He's old enough, awake enough
and sucks well enough that SIL can throw out a lot of what the nurses said
in his first two or three days.

> Sounds like a good idea for the long term. Remember to tell her she is
> doing great as well :). (((hugs))) to you, SIL and your nephew.

Thanks Di. I've been sure to praise her every step of the way, even when
she thinks its going poorly.

--
Rhiannon
Mom to M. Girl and O. Boy

[Di]

On Tue, 21 Oct 2003 05:14:02 GMT, "She's A Goddess"
> wrote:
>Yep. We had a great LC appointment on Saturday where the nipple shield was
>introduced, mom and baby got a *good* latch and nurse session and mom got
>some confidence. So since then he's only had a few bottles in the middle of
>the nights when they are both to sleepy to get it correct. I've convinced
>her that will have to stop soon but one step at a time, right?

That is fantastic news. I hope you can get her to cut out those last
few bottles soon as well :).

Di