hi april,
i don't know if the baby actually 'burns up' more calories by nusing past 30
minutes, but i do know that 33 wk babies often lose weight and get into
10, 14 percent wt loss situations quickly, because they are bf
ineffectively. they are not transferring much milk and so are not using
those 30 minutes
for good calorie intake. the only way to know exactly how much the baby is
drinking is to use before and after bf weights, on a veryu sensitive digital
scale,
typically accurate to +/- 2 grams. Each gram of weight change = 1 ml of
intake. These scales can be rented for use in the home. In all fairness,
there is
controversy over the use of these "ac/pc" weights, however, I feel there is
sufficient research to accept their application in situations such as you
describe.
One could also use daily weights or every other day weights to see how baby
is doing and help decide what the supplementation should be.
There are quite a few ways this mother could manage bf with this baby. Here
are some examples: bf with breast compression, switch nurse when swallows
slow down, supplement with pumped milk afterwards, via spoon, cup, finger
feeding, or paced bottle feeding. if baby has a good strong latch and
suckles
without fatiguing too soon, a supply line could be used to deliver the
supplement.
When a baby falls asleep at breast or nurses while sleeping or with eyes
closed throughout, and that baby is a premie, one can be reasonably certain
that
said baby is transferring very little milk.
I am sure that there are 33 wk babies who can be totally fed at the breast,
I beleive they would have to be in 24/7 kangaroo mother care, and have very
frequent
feeds, much more than the usually cited 8-12 x per day. I have never seen
this accomplished, working in the typical Western hospital system/nicu
environment.
Mothers in this culture have not been acculturated to kangaroo care their
babies, and instead are modeling the every 3 hr feed pattern.
Hope this is helpful to you,
Laurie Wheeler RN MN IBCLC
Mississippi USA

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