My baby was born at 36 weeks and has been in the NICU for 2 and a half weeks. She was a very sick little girl with Respiratory Distress Syndrome and Pulmonary Hypertension. She was not fed anything (got fluids, vitamins and lipids through IV) for about a week and a half at which time they started giving her my breastmilk through NG tube. Then we started attempting to nurse a few days later. After a few days, she finally got the hang of it, and now she is nursing quite well. I am able to stay here with her at the hospital 24/7, so that has been such a blessing! The problem is that she has lost a lot of weight. Last night she finally had a gain of 10 grams rather than a loss. We were so excited about that, but the doctors are still not impressed. They want to see her gain at least 30 grams per day for 3-4 days consecutively before they will think about discharging her. They are going to start the NG tube again to give her more of my milk while I also continue nursing. If that doesn't work, then they want to supplement with a bottle. I am feeling very discouraged. I have tons of milk, and it seems like she's getting quite a bit. One idea they gave me was to pump some off before I feed her so that maybe she will get less foremilk and more hindmilk. Does this sound like something that could work? I am getting so many different opinions from the different nurses and doctors. My feeling is that I should nurse as much as possible. But some are saying to let her sleep more (I have to wake her up to eat most of the time) and that she may be having to work to hard/burn too many calories if I'm nursing too much. We have only been successfully exclusively breastfeeding for 3 days, so I feel like it's normal she hasn't gained much yet, but they are concerned. Any advice/insight as to how to get her to gain is appreciated. I really just need to get her home!!!
Re: Weight gain
I am so sorry that you and your baby have had such a rough start!
30 g (1 oz) of weight gain per day is fractionally on the high side for some babies, but I think that with a baby who has had such a difficult beginning, it's reasonable to want her to catch up.
Is baby always being weighed in the nude, using the same scale every time? When weight gain is such a concern, you want to be sure that proper technique is being followed.
The idea of pumping off some foremilk so that baby could get more hindmilk is not awful, but not necessarily great, either. In general, quantity of milk is far more important to weight gain than quality of milk. A baby will gain perfectly well- in some cases, exceptionally fast- on a diet of so-called "foremilk" alone. If pumping off more milk meant that your baby got the same amount of milk but it was richer in fat, then she could potentially gain a little faster. But if she's not yet a great nurser, then pumping off the foremilk could mean that she gets less milk overall, which is not going to be helpful.
One thing you might try is to weigh baby before and after feedings, using a scale that is accurate to the 1/10th of an oz. The hospital should have one. By subtracting the before from the after, you can gain a very accurate assessment of how much milk your baby took in while nursing. If it's close to 2 oz, there should be no need to supplement. If it's less than that, maybe supplements are necessary.
I can't comment on the let baby sleep/wake baby up issue. It seems to me that more nursing = more calories, and more nursing sessions can be very important when you have a small, sleepy, and/or premature newborn. But in your child's specific case... I think this is another reason the scale could be useful. At this point you don't know how much she gets when she nurses, and that amount would give you a better sense of what you need to do in terms of waking her.
If you are going to supplement, one avenue to try would be to supplement with "double cream" milk. You pump a bottle, let it sit, and when the cream separates out and floats to the top, you pour that into another bottle which is then fed to the baby.
Stay strong, mama!
Re: Weight gain
I'm sorry about the NICU stay. We just went through this for 2 weeks with 35 week twins. It is very stressful and they won't consider 10g wt gain all that significant, they want to see at least 20 or so and a trend for a few days. For me, yes the scale can be useful. I thought my boys were getting much more than they were at breast because after nursing they wouldn't take as much expressed milk in a bottle but really I think it wore them out. People differ in opinions on how tiring nursing is but for us, it did help to limit time at the breast in order to get them gaining well on my pumped milk.
When they get bigger and stronger they can nurse better. At some point of course you want her to be waking to feed and requesting to nurse/get milk however you get it into her. It felt like a step backward almost to start bottles but in my situation it's what they needed and now at 5 weeks old/40 weeks they still need me to pump and bottle because they are not all that great of nursers- still not incredibly mature or organized.
I know not all preemies are like that but it does happen. They really wake up around their due date and my LC said the first 2 weeks of any baby can be hard with nursing and the 2 weeks starts at due date so she's hoping for good progress by 42 weeks gestation.
Re: Weight gain
dd was not in the nicu, but was delivered at 37 weeks was only 2.2 kg, had slipped down to 1.9kg on dbf, so had to supplement for almost 45 days.Her weight gain was low initially around 10 to 15 gm , she did better with minimal supplementation. I saw her gain weight only after1& 1/2 months .It took her that long to become more efficient, she did not do a great job of transferring milk though i had abundant. So hang in there these guys do take time but eventually they will
Re: Weight gain
Thanks for your replies! We had a great nurse last night (she nursed her son for 5 years), and she was really receptive of the ideas you gave me. She put the "double cream" in the tube feed. We didn't do the weighing before and after feeding because she said the scales here are not that accurate, and so it would probably just be frustrating for me. The awesome news is that we had a gain of 53 grams for last night!! She started cluster feeding yesterday, and I think is just becoming more effective and emptying me better. We also did the weight check about an hour and a half after the 60 ml tube feed. Did we wait long enough?
During rounds this morning though, the nurses practitioner got onto me for the cluster feeding. She said that nursing her for an hour is really not going to be effective and will make her burn too many calories and that I should put her in the bed and give her the pacifier and let her sleep! I am just not going to deny my hungry baby. I don't understand why she said that, when obviously whatever we did yesterday worked. Do you agree that I should ignore her advice and just follow my baby's hunger cues?
Their plan now is to still give her this one tube feed today, and if she has gained well, take it away tomorrow and watch her for a couple more days. So ready to get out of here. Hoping we are on the right track now!
Re: Weight gain
I was told the same thing about the scale by a nurse and asked the LC and she said yes they're accurate but they don't want moms to stress out about numbers. Plus it's hard to unhook babies from all the cords or hold the cords up for a good weight and some don't want to bother helping with that. Anyway of course their scales are accurate, why else would they be trusting that your child gained 53g last night?
I don't know about feeding for an hour. It didn't work for us but my babies were not removing milk well. I know Dr Jack Newman says it doesn't wear the baby out because babies respond to the flow and they're not expending much energy if they're not taking milk fast but in our case our babies did need to be limited at breast time in order to have enough energy to take milk from a bottle. It is hard being a preemie and they do need to essentially gestate a bit longer and sleep a lot. They wouldn't normally be nursing before their due date, they'd be gestating so I just wouldn't stress her out.
Do you have a NICU LC you can meet with? and ask about pre-post nursing wts again.
Re: Weight gain
The NP may be used to more significantly preterm babies than yours. Babies who are born very early are often too weak and small to nurse- they aren't effective feeders and can end up exerting themselves too much for the amount of calories they are able to take in. But babies who are born late preterm, like yours, are often large and strong enough to to get plenty of milk when they nurse. Their major problem isn't burning too many calories trying to nurse, it's staying awake long enough to nurse.
Originally Posted by @llli*carolines.mom
I personally think that you should feel free to follow your baby's cues, particularly following the good gain yesterday and the plan for "double cream" supplements. If it's not working, you can always try another avenue- but why not give what you're doing a chance? :)