Pre-Aptimal for Prem babies - Advice please

[rascal1979]

My baby was born at 30+6 and is now just over 3wks old. She was 983g born and after losing a little weight she is now upto 1125g (2lb 5oz). She is being tube fed my breast milk and is starting to Breast feed a little too. However although she is gaining weight the Dr is concerned that she is not gaining enough and wants to split her feed so that she is having half breast milk and half pre-aptimal formula.

I'm really not keen on giving her anything other than Breast Milk and have told the Dr I want to try things like more skin to skin to try and increase her weight gain. The Dr has reluctantly agreed but made me feel as though I'm harming my baby. The SCBU nurses have made me feel pretty much the same - the only person supporting me is the breast feeding co-ordinator.

Feel really confused as I don't want her to suffer but as I see it if she is gaining and not loosing then that is a good sign and rushing in with formula after 3 weigh-ins (over 1.5wks) seems a little OTT.

The hopsital she was born at (she was transferred to her current hospital on Xmas Day) used fortifier in her milk - but only started on the day she was leaving - but I'm not too clear on whether this is okay either - I don't think that the current hospital would allow her to have fortifier - they mentioned something about it being linked to gut problems.....

ANyone in/been in a similar situation or can offer advice?

[sweetkitty]

I haven't been in this siutation but someone else was recently with a premmie, I think it was sparklygothkat - have a search using her name under breastfeeding. Or someone else who knows more will be along soon.

FWIW I think you are doing a great job, your DD will thrive more on your milk than anything else.

[Swaliswan]

Congratulations on the birth of your LO! Well done for BFing until now. My LO wasn't as prem as yours but I still remember the endless time spent expressing and tube feeding then trying to establish feeding while the NNU nurses were telling me that I could be making DD lose weight by BFing her. When she was at about her due date she was putting on 10-12oz a week despite losing 10% of her body weight to start with. I later found out that the BM of a mother who has had a premature baby is different in it's contents to the milk that a mother of a term-baby. Mother nature is very clever. I was thankfully never put in the same position as you are now so I'm bumping this for you in the hope that someone more knowledgable comes along.

As far as the concern about fortifier and gut problems goes, I would point out that BM protects against gut disease and formula does not so maybe they could discuss this with you further Could you contact BLISS for some more info?

As well as kangaroo care, you could try baby massage if you are allowed. It is known to increase weight gain in premature babies and certainly helped my DD.

Hope this helps and that things work out in a way that you are happy with.

[rascal1979]

Thanks _ I've found the thread that sweetkitty referred to and have tried to ring the ABM - the tel number goes through to trained people in their own homes - However when I just rang I got some bloke who said I needed to speak to his wife and she wasn't in ! Very useful

Feeling really crap about it all the staff are rather set in their ways and I don't want to give in and do what they say as I'm so against it but neither do I want to make my baby suffer or not gain weight.....

[loucee]

Rascal sorry I don't have experience of this but have you tried any of the other breastfeeding organisations? I have always found La Leche League really knowledgable and have lots of fact sheets to hand if necessary.

Whereabouts are you? Not that it makes any difference I am just curious.

[sweetkitty]

rascal - glad you found the thread I'm sure SGK or one of her sisters will be along in a bit.

[moondog]

Racal,it's a bit late.
Try the number again tomorrow.
There are lotso f other organisations too.I'll link you up with a nexcellent website..

[moondog]

All useful numbers on the right hand side.This website put together by MN's own HunkerMunker

[Pannacotta]

Your baby wont suffer by having breast milk alone, that is nonsense. Am surprised you are not being supported in wanting to breastfeed your baby.
DO try calling La Leche, and am sure someone on here will come along soon and offer more advice/support.
Some info here whcih might be useful for you
www.kellymom.com/bf/preemie/preemie-links.html

[rascal1979]

I've just rung La Leche - some okay advice but not really that helpful TBH.

Plan of action tomorrow is to suggest;

1. Reduce to 2hrly or 1hrly feeds but increase the volume over the 24hrs
2. La Leche said that if I am small (I am 5ft) then baby is more likely to be small anyway
3. Maybe try baby massage
4. La Leche said that if she is healthy and has wet and dirty nappies and is gaining weight steadily (which she is!) - even if it is slowly - then this is fine and no need to add formula or fortifier.
5. Maybe suggest creaming off the hind milk

Feeling tired and teary and soooo fed up at the moment. All the staff are really unsupportive and if you dare question anything they are very defensive - don't think that it is helped by the fact that my Baby was trasferred from a regional SCBU hospital to my local SCBU - they seem to be paranoid that I am comparing them all the time

[rascal1979]

loucee - I am in Manchester

[loucee]

Your plan for tomorrow looks good Rascal.

I've recently been in the SCBU at my local hospital in Scotland with my DS, it was a long shot but just wondered if you were in Scotland too.

No wonder you are teary, there doesn't appear to be any reason for the push to give the pre-aptimil given that your baby is doing all the right things. Hope you get some rest tonight and that the plan goes well tomorrow.

[tiktok]

Rascal, the breastfeeding helplines are (wom)manned by volunteers in their own time in their own homes - this means that some of them are out when you phone. The BfN and the NCT lines are organised a bit differently and when you get through it will be a person who is 'on duty' but they are still women in their own homes volunteering. I think BfN takes calls to 9 pm and NCT to 10 pm.

You are in a difficult and worrisome place with such a teeny new baby - it's great you have some support from the breastfeeding co-ordinator. The nutrition of prems is not a cut-and-dried issue and there is often room for debate about what the best thing is.

Fortifier is formula, basically - made from hydrolised cows milk proteins and sugars and concentrated. I don't know of it being linked to gut problems, sorry.

It will be helpful for you to talk with a breastfeeding support person tomorrow, but they won't be able to comment on the medical side of things - they will help you with information and support you, though.

[sparklygothkat]

Hi, I had Callum at 33 weeks, and we have struggled with BF. The best thing for a prem baby is breastmilk (but I guess you know that ) I was lucky in SCBU because noone pushed formula and I had huge amounts of expressed milk in the fridge and freezer, its only now that he is home and wasn't gaining weight we had to start with formula. I can't see why they want to give her formula, she is gaining weight. As for the nurses, its easier for them to give him formula, especially if they can bully you into bottle feeding. I had nurses and doctors asking if they could give Callum a bottle of EBM.

[moondog]

Rascal,how did it go today?

[rascal1979]

Hi All
Thanks for the replies

I had a chat with the senior nurse today and she has said that my DD will be okay staying on EMB just won't gain as quick but this will do her no harm. If I change my mind she can go on it to weight gain but come off before going home.

They think that that she will still be in onher due date may be a week or two after before she comes out if she stays on EBM BUT I'd rather wait an extra week for her to come home if it means no formula.

She said that the Dr's often 'jump in' and are very clinical about these matters.

She has suggested slowy increasing her intake over 24hrs (currently 180mls per kg and can increase to 210ml/kg) which shoul dlead to more weight gain. But if not so long as she is gaining something this is fine.

next weigh in is tomorrow night so fingers crossed she has put more on! I've done skin to skin and she has slept a fair bit today so hopefully she will have.

Will keep you posted!

[moondog]

Oh great.
That all sounds good and it seems as if people are supporting you in your decision.
Yes,please keep us posted.

[rascal1979]

Hi All

Just had her weighed and she has put on 65g since sunday - Yay!! Nurses are happy and have increased her feeds.

Fingers crossed she continues!

[Pannacotta]

Thats great news rascal, well done and hope all continues to go well.