When did your preemie master breastfeeding? (And what is "weeks adjusted"?)

[ThisIsActuallyHappening]

Hi all,

Our beautiful DD was born at 33+3. She's now 35+6/17 days old and is thanks to an amazing SCBU team thriving. The ONLY (ha!) thing stopping us going home now is that she needs to learn to BF (currently still tube fed). They keep telling us that week 36 is a turning point and she will suddenly get it and that we should be home next week ...really? She will latch on, but doesn't currently have the strength to manage more than a minute or so of feeding before she falls asleep (!)

Today they have pushed her back to 4 hourly tube feeds in the hope that it will motivate her to try harder with BF.... But her feed is now an hour late and she isn't rooting or anything :-( Just about to do a nappy change to try to rouse her a bit.

So when did your baby get it? And I tips? Apparently the latch and my positioning is great which is luck rather than judgement as I'm a new mum lol, but she doesn't seem alert enough to sustain a feed. Will a day or two rally make that much difference in terms of her ability to do so?

Also what does week's adjusted mean? Is that how we explain that she is 2 weeks old, but premature? Otherwise people will think she is "behind" development wise because I guess she won't reach milestones like a full term baby of the same age would?

Any info or advice greatly appreciated, thank you.

No advice on the breastfeeding but as far as I'm aware 'weeks adjusted' is the amount of weeks before she was full term? So if she was born at 33 weeks I think you'd say '7 weeks adjusted' but I'm not 100%.

I only know this because of an 8 week prem baby at the nursery I worked at was given a 2-3 month leeway but it didn't really make much of a difference, she still took steps in her development etc xx

Many congratulations. As far as adjusted age goes she's yet to be born! As she's a 33 weeker when she gets to be 8 weeks old from birth (actual age) she'll only be 1 week adjusted - you count from 40 weeks/due date.
As for the breastfeeding it really depends. My 30 weeker was too small then unfortunately too weak from infection to breastfed exclusively so was discharged on 7 out of 8 feeds from bottle when he was 37 weeks. We then managed to eliminate all bottles when he was 14 weeks old (4 weeks adjusted). Hopefully she'll keep getting stronger every day and can come home soon either just BFing or being supplemented with tube feeding. Best of luck.

Congratulations! My son was born at 34+5 and stayed in NICU eight days. He managed a couple of decent bf before we left but, just like your DD, was basically not strong or awake enough to keep it up. He came home still very much tube fed with expressed milk. He kept the tube in under the supervision of the community neonatal nurses, who visited every couple of days and monitored his weight extremely closely while he continued to build up more frequent bf. He yanked his tube out at some point when he would have been full term so at least 37 weeks, though I forget exactly when and the medics then decided he'd be OK without it (and he was). I think support is all important -- the nurses in our NICU room were extremely supportive of the early steps towards breastfeeding and we got loads of advice and encouragement in a calm environment, but the community team were much more focused on weight gain above all else and pushed for mixed feeding. We did this for a couple of days, but it didn't go down well (it later turned out he has a dairy allergy), so we went back to expressed milk. Things which made all this easier were hiring a hospital grade breast pump to use at home (Medela certainly used to give you a discount if you were the parent of a NICU baby but you have to ask), and then once we were home we paid for a lactation consultant to visit us. She only came once but she really helped with positioning, confidence etc. Obviously that costs money, but it was a real help for us in making the transition between the heavily medicalised and stressful hospital situation and a new 'at home' normality.

My DD was born at 32+6 so similar gestational age to yours. She was in the SCBU for four weeks, and they took her feed tube out about a week before she went home. Prior to the tube coming out, she was on a combination of tube feeds, bottle feeds and breast feeds, and even when she went home (at 37 weeks), the paediatrician told me to supplement her breast feeds with the bottle as she still wouldn't have enough energy to get all her needs from breastfeeding alone.

Like yours, she wasn't able to breastfeed for more than 30 seconds or so at first. I remember the nurses saying that the sucking mechanism kicks in around 35-37 weeks, and that is actually the reason that hospitals now deem 37 weeks to be 'full term' - because by that age most babies should be able to feed on their own (it used to be that anything less than the full 40 weeks was considered premature). IIRC, I think 36 weeks was about the time she started to get the 'hang' of breastfeeding, and was able to feed for a few minutes at a time. I do remember something just sort of clicking then - even though she was only able to feed for very short periods, I could feel her latch just suddenly felt 'right', instead of shallow, and it was like she was really getting the milk this time. My supply improved no end just from those few minutes of feeding. By the time we left the hospital she was doing full feeds, although she often fell asleep suddenly in the middle of them, like an old drunk

The thing to remember about preemies is, as another poster pointed out, that they aren't supposed to be here yet - they are meant to be in the womb. So of course they can't feed for any length of time, and that's why they just want to sleep the whole time, and they barely even cry. (I remember what a shock it was when my DD suddenly developed a full-throated newborn roar right around the time she was due to come home, after my being used to her just mewling occasionally like a weak kitten ) But the other thing is that they change SO quickly. Literally every few days new skills and strengths are 'coming online', so I wouldn't be worried that yours can't feed for long now. It's great that she already has a good latch - that's most of the battle.

Btw, every mother of a preemie that I know has struggled with milk supply issues, even after their babies get older and stronger. IMO nothing can make up for those lost first few weeks, which is when baby is supposed to be feeding constantly and your supply is really established. I pumped assiduously since DD was born, and she eventually became a strong feeder, but it was always an uphill battle to make enough milk and we always kept a tin of formula on hand. A friend helpfully gave me some breast pads, saying they had saved her from many embarrassing moments, and I never needed them! Never had issues with overflowing breasts. Quite the opposite

I second Malva's suggestion to hire a hospital-grade breast pump if you haven't already. The home ones just aren't powerful enough to keep up your supply while your baby isn't feeding. Also, and this is a bit random but I thought I'd mention it: anecdotally it seems like prem babies are more prone to developing reflux, possibly due to having the feed tube in for so long, so keep an eye out for that and get it treated ASAP if it becomes a problem. My DD developed terrible reflux and that was the main health issue we had once she came home. It was OK once she got proper medication though and it cleared up completely soon after she started solids.

Our son was very premature so I was expressing already. I stopped pursuing BF as the only choice about a week before he was discharged from NICU, as he still wasn't maintaining a latch - I didn't want his discharge to be delayed due to poor feeding. Instead I pumped and bottle-fed him EBF ... for eight months ...

Oh, and on the 'weeks adjusted' thing, when people asked her age we always gave her adjusted age rather than her actual age, as that is the age by which you measure their development. Most of the time I didn't even bother explaining the adjusted age thing because most people don't get it. Even some medical professionals don't get it - our first health visitor said there was something wrong with DD because she hadn't smiled yet at 8 weeks old, when the SCBU paediatrician had told us not to expect her to smile until she was 13 weeks, or 6 weeks adjusted, which is when she actually did smile.

So if people would ask 'how old is your baby', I'd answer 'four months', instead of the nearly six months that she was. We give her actual age now that now that she is nearly two, although apparently you are supposed to keep correcting for prematurity until two and half, and I have noticed that she still looks younger than the average two year old.

My DD was born at 32+5 and from the day after she was born she started latching on but not really getting anything/falling asleep after a few sucks increasing to slightly longer feeds then at 34+5 she suddenly seemed to get it and started taking full feeds and came home 4 days later. They told us that one day she'll almost just wake up and 'get it', which she did! after the first day of this she then had a bit of a sleepy day which they warned us could happen and the last two nights I spent in hospital with her exclusively breastfeeding with no tube top ups and they let her home. So it can and does happen very quickly!

Also I've got no idea if this actually made a difference but I used to try giving a breastfeed then keep her on the breast while she had her tube feed so she would associate being on the breast with being full. It might have made no difference but I was willing to try anything!

Mine was 29 weeks, in NICU until after due date.

I pumped religiously every four hours from the day after DD was born and managed to keep up with her demands so she only ever had bm so I didn't have supply issues.

BF itself was not established until 4.5 months after she was born. It was a v long slog. I did buy a hospital grade pump.

We actually carried on until nearly 3 years old because DD was neutropenic, had heart surgery and had multiple allergies so it just seemed easier.

Our DS was born at 33+6 and we never managed breastfeeding - largely because I didn't have any supply at all (literally none).

As far as I know, the reason week 35/36 is a turning point is because that's when their suck reflex develops - so I suspect he would've struggled with breastfeeding anyway.

I always go by his adjusted age for anything relating to his size or development - as pp said it gets confusing and a bit irritating to keep saying "oh he's 11 months old but 9.5 adjusted" so it's easier to say he's 9.5 months!

The only things the "actual" or "chronological" age (i.e. From birth) are relevant for are: age of vaccinations, and age to start weaning.

Hope you get home soon!

My preemie was born at 33+6. She was NICU then HDU so we only tried bf once she transferred to SCBU at 10 days old. At first her suck reflex was pitiful, a couple of sucks and she'd fall asleep. They used to tube feed her whilst I held her to the breast, to try to get her to associate getting food with sucking.

It took a week or so but as she got stronger, she'd take more until they didn't need to top her up during the day. She was still a bit skinny though so at night when she was still tube fed they supplemented the expressed milk. A week later we took her home, bf every 3 hours.

The adjusted is for milestones, so you say the age they'd be if they were born at term. Vaccinations and weaning are done at actual age not adjusted though.

Best of luck xx

My preemie was born at 31+3. He was on a ventilator for two days and when he came off he immediately started rooting and sucking. He was given a dummy to support his suck reflex. He started sucking his thumb after a week in SCBU and so they encouraged me to put him to the breast at 10 days old. He was able to latch on immediately. We then did one or 2 small breastfeeds a day and the remainder was tube fed. If he was seeming unsatisfied when I wasn't there, they gave him a cup of ebm because it mimics the motions he uses for breastfeeding. We were able to go home on an early release programme when he was 29 days old and 3lbs9oz with his feeding tube and nurses coming out to advise. Once home, we were able to establish bfeeding exclusively and his feeding tube was removed after a week. We have managed 15 weeks so far but a lot of this has been luck because he was a very eager feeder. I had a good pump and expressed every few hours.
Congratulations on your brand new baby x