Toni Meyers posted about a 36 week pre-term infant, released home with
unsupplemented bfg.  Baby had marginal gains (.5 oz per day) for a few
weeks, and then dropped off and needed supplementation.  By now mom has low
milk supply.  She asks for advice.

I see quite a lot of these 35-37 weekers who are latching, and doing some
bfg but aren't really robust, coordinated feeders.  These babies can fool
you into thinking they are doing something when really, they aren't. They
need a diff. kind of management than a term infant, and this will often
include post-feed pumping with a hospt. grade pump with the pumped hind-milk
fed back as supplement.  Such babies often lack stamina.  If you watch them
closely while feeding, you note immature sucking bursts characterized by
fewer than ten sucks. (Mature sucking is characterized by 10-30 sucks prior
to a pause in the early part of the feed.)  Pre-term infants pause very
frequently, the pauses are long, and the babies coast on fore-milk.  Once
the positive pressure "push" of the let-down subsides, these babies switch
to a non-nutritive sucking pattern, fall asleep at breast, and fail to
really finish the feed.  Over a few weeks time, unless mom is pumping
afterwards, the poor breast drainage begins to result in diminished milk
supply.  The extra milk of the engorgement phase has been all that has kept
the baby with a marginal gain.  As engorgement subsides, you wind up with an
acquired low milk supply.   So just as the baby gets to the age where
neurological maturity sets in, and they are ready to go, the milk supply
isn't their to sustain them.  Plus, their poor growth creates poor energy,
and you get a vicious circle going.

I watch my clients who have pre-term babies very closely.  I think they need
the advice to feed very frequently, and to use deep breast compression while
feeding.  They need to be taught excellent positioning techniques, because
these babies need extra postural support to help them compensate for
structural deficiencies caused by low tonality (common in preemies) etc.
Post-feed pumping is, in my opinion, the big safety net.  I'd rather see the
babies supplemented (with own mothers milk) early rather than later.

Barbara



Barbara Wilson-Clay BSEd., IBCLC
Private Practice, Austin Texas
Visit the "LactNews-On-Line" Web Page
http://www.jump.net/~bwc/lactnews.html