Bonnie, in the two private hospitals where I do occasional consults (not
BFHI hospitals, but "baby-friendly" mostly, all the same) the *really* prem
babies are fed every two hours (usually by nasogastric tube), and then they
graduate to 3 hourly feeds.  Four hours is definitely considered too long.
The mom will work with her baby to get him to breastfeed, and if he is just
too sleepy, then he is topped up either by spoon, or by NGT if one is still
in place.  Once they are discharged (over 1800g and healthy, whatever the
age) I always urge moms to ensure that their babies eat *at least* every
three hours (more often if awake and eager, naturally).  It's amazing how
these little mites can appear to be asleep yet glug down EBM from a spoon if
it's offered.  And how the weight can fall off if they are allowed to sleep
too long without eating.  They always seem to be much more active at night
than during the day, and I find that the mom gets really discouraged that
one breastfeed can go so well, yet the next one can go so badly.  I see this
as *normal* for prem babies though.  Once they are off the ground they are
weighed every other day and the paediatricians expect a gain of about
20g/day. Once the baby is really going well the paediatricians will want the
baby to receive as much as 220 ml/kg/day of EBM. One of the babies I worked
with was gaining a whopping 60g/day just before discharge, on breastmilk
alone.  I see the Rule # 1, FEED THE BABY as being even more important for
prem babies, to maintain their energy and growth so that they can take over
feeding for themselves asap.    Hope this helps.

Pamela Morrison IBCLC, Zimbabwe
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