Hello all,
Baby born 25/6/02 week 32. Weight 1.630 Kg. Today reached due date and weighs 3.800.
All peds that she is in touch with insist she continue with HMF and expressed bm and when not enough expressed bm, then she must give neosure. Her question to me was, since her pumping is having the opposite effect and her supply is dwindling, what can she do to increase her supply?  Peds (many, not only one!!) forbid her to breastfeed straight from the source more than 3 x day.!! They say that she has to give HMF for at least half of the baby's intake which they assess at 500-600  cc/day. and this is to continue until 4 months. I asked her if that meant another two months? or another 4 months corrected date. She did not know the answer.

 I asked her if there was a medical indication that this practice should continue and she said that she doesn't know but that she has no option.  I felt that she really didn't know anything concrete and didn't really think to ask. I also did not want to sound too emphatic so I suggested to her that

 1) she should get some answers in order to verify the medical validity to these recommendations.  I brought up all the stuff from Nils Bergman on bf and preemies assuming there are no medical limitations. Explained that by limiting bf to only a few times a day wasn't going to be too helpful in increasing the supply.

2) Assuming that she was going to follow thru on MD's recommendations I suggested to her that she go over to total bfg. Baby nurses beautifully (with silicone shields, Oy! Also suggested that a visit could enhance her bf technique to be less painful. ) But to carry out Peds request she could add the HMF to 25 ml of ebm with the help of an SNS. Feed on both sides (or on one side 50 ml and two sachets.) that means that she would only have to connect and use SNS with some of the meals (if half daily intake is 250 cc that means 10 sachets.) Baby would eat more frequently (perhaps) due to going over to breast vs. bottle (which she is prepared to do.) If she eats more frequently at the breast then maybe the peds would agree to lessen the HMF as they see progress. All this of course, together with the peds blessing (?)  or at least knowledge.

Do you all think with these stats this baby needs HMF? Neosure?
Here in Israel, it is rare to report to the attending PEd re breastfeeding. Unless of course, he/she is one of the few MD's who have full cooperation with an LC. The ideal would be to speak to the MD but there isn't really such an arrangement, and the MD's don't have the type of relationship with most of us to encourage such a practice.

This consult was over the phone - I encouraged her to become more acquainted with preemie practices elsewhere, where exclusive bfg is more the norm, and if her peds agree to "allow" her to try this, then to call for an appt. to help her get started. Meanwhile I am in touch with the head of the dept. in another hospital where I hope to get "another medical opinion".

Have a great weekend and a great week.
Ellen Shein, LLLL, IBCLC,
Tel Aviv

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