weight gain - stress! fortifying 2 bottles/day

[@llli*annie.menuey]

so stressed about this. just want ydd to "chub up." in good news, my previous two kids seemed to react to something in my milk/diet, and I've worked for the past three years to improve my gut health. though I had no indication that it was improving, this baby doesn't seem to be reacting to my milk and seems comfortable - that's awesome!

dd was born RIGHT at 33 wks due to my severe pre-eclampsia. first two were free standing birth center and homebirth, so hospital, c/s, and NICU were new (sad ) experiences. but dd was healthy; just very, very small. 3lbs 10oz at birth, which on their chart was 15th centile. only found that out reading her discharge papers almost 3 wks ago. no one ever discussed her percentiles. she was gaining great weight in the NICU - usually one oz or more/day. she was getting my milk but it was first fortified to 24 cal/oz then to 22 cal/oz. i never had my milk tested but it's presumed to be the average 20 cal/oz. the fortifier was called human milk fortifier but it was dairy based. I've heard of prolacta, which i guess is made from human milk, but i never even brought that up in the NICU, and thankfully dd tolerated the fortifier well.

discharge plan was to give her at least two bottles fortified per day and then nurse the rest of her feedings, offering the bottle after. she's still using the nipple shield which I'm honestly fine with and will work on weaning once weight gain is going well. day after discharge, she was 5lbs 1.2oz. the ped (who is natural minded which I really appreciate) was OK w/ us just nursing and not doing any fortifying. so we did. at the weight check, five days later, she had gained 4.5 oz, and was up to 5lbs 5.8 oz. the following week she was up to 5lbs 11.2oz, so up 5.4 oz in one week. ped was ok. I was OK until I looked at the percentiles. at birth, and through her stay in the NICU she was 15th percentile. then once she stopped getting the extra calories via fortification she went down to 11th, then 10th percentile. I'm weighing her on our kitchen scale and she's currently 6lbs 0.3oz. up 5oz from last Wednesday. we've been doing two bottles of fortified milk per day, adding Enfasure to make them just about 23 cal/oz. but I'm not sure that's enough?!

thankfully ped is OK but I'm nervous if we don't keep up w/ the fortification (or perhaps even do more than we're doing?!) that DD is going to keep dropping percentiles... she clearly was on the 15th from birth right through her 25 day NICU stay...

did anyone else struggle w/ weight gain once stopping NICU fortification? what did you do? if anyone knows any links to preemie growth charts other than this one, I'd really appreciate it, also. http://www2.aap.org/sections/perinat...owthCurves.pdf

eta clearly i need to update my sig from 2008; DD1 was born in 07 but that must've been pregnancy brain typing 08. oh my. lol

[@llli*mommal]

Bump

[@llli*annie.menuey]

thanks for the bump; maybe this is not an issue many people are dealing with? I'm having a hard time figuring if my little girl is just genetically small or if she really is not getting quite the nourishment she needs. I do have a tendency to worry and be anxious about things, so it's also hard to tell if this is not a big deal, kwim? but a drop from 15th to 10th percentile in just over a week is what jumps out at me. I don't want to get on a downward trend and keep dropping percentiles.

we're offering two bottles of 80mL of milk mixed w/ 1.5tsp Enfacare per day. that should bump it up to about 23 cal/oz. she's drinking 60-75mL of that. I think I called it Enfasure originally - it's the Enfamil preemie formula. Anyway, been doing that since Sunday. her rate of weight gain seems maybe slightly increased; per my scale she was up to 6lbs 1oz yesterday from 5lbs 11.2 oz last Wed. 5.8oz gain in a week... and from what I can tell we're flirting w/ 6lbs 2oz today just want her to plump up, though... I have a growth chart from our ped as well as the one I linked before; their #s vary a bit as the one from the ped shows 10th percentile being ~6.5lbs at 40 weeks gestation and the one I linked has 2850grams which is more like 5lbs 5oz, which we *might* hit by Monday, her official due date...

thanks for any support! I've gotten in touch w/ a student midwife who I knew from her having been a LLLL and feel good having a real life person to bounce stuff off. going to keep up w/

[@llli*smudge]

**HUGS**. It sounds like this is a very tough time for you.

Please don't get so focused on the numbers from the growth chart. They have their place in watching for signs of growth but so is looking at your child. Remember that the chart is just numbers! And the percentiles can be very confusing depending on which chart is used and making adjustments due to prematurity. It sounds like you are working closely with your pediatrician which is a much better way to track growth & development than a chart of numbers. If you are really worried, you can contact the neonatologists at the NICU or get a second opinion from another pediatrician.

Take a deep breath. It is clear that you care deeply for your child & are doing everything you can to care for her. You are an incredible mom who has been through a lot of challenges recently. I am so impressed with how well you are doing. More hugs!

[@llli*annie.menuey]

Well, we had an IBCLC appt last week and she gave me some encouragement, too. I'm feeling a lot better, but mostly encouraged by the fact that she does in deed seemto be gaining an ounce per day! She was 6lbs 3oz on Friday, and from what I can tell she's close to 6lbs 10oz today!!! Amazing! We're still doing the fortified bottles but I think she's really just nursing a lot better - I'm waking her to eat.

I'm now really bummed about her failed hearing screenings; in the NICU right before she was discharged she was "referred" in both ears after being tested twice. I didn't think much of it as I just figured she must have still had fluid in her ears or something. So she was just tested on Monday and failed again. We have a 2hr test coming up next week which should be more diagnostic. But I'm just heartbroken over the thought of her not being able to hear; we've not seen her react to any sounds here at home