Hi Debbie,
Pat is so right about preterm babies. At that gestation, his course could
have involved a lot of illness and interventions, ventilatory support, and
delayed feeds, gavage feeds, etc or he may have done very well and began
suckling at the breast very early on.

His mother may have been very sick as well, or may have been doing well,
getting good, early help, and established a good supply early on. However,
I am doubting that, since she is consulting you at 7 wks.

Ideal is for baby to regain birthweight NO LATER than 2 wks of age, but
that is pretty late for a term baby. For premies, it sort of depends on
when they start full strength by mouth feedings, not relying on IV's etc.
In my experience there will be weight loss until full feeds are reached.
Most premies have delayed feeds and gradual build up to full feeds. So it's
complicated. Once gaining, standard is around 20-30 grams/ day.

I think your first consult will be to get a thorough history, exam of both
mother and baby. Obvious things will present themselves, I'm sure, like if
she's breastfeeding, how effective are the feeds, how often, how does baby
handle feeding stamina-wise, etc. and just generally is she expressing
optimally (flange, frequency, duration)?
You will have to handle only a certain amount at first consult, if it's a
complex case. Weight gain checks are SUPER IMPORTANT and frequently needed
maybe 2x per week at first, depending on what you find. And involvement of
the baby's primary healthcare provider is SUPER IMPORTANT also.

Pamela Morrison has shared a WONDERFUL synopsis of how she handles
underweight, not gaining babies. Recently this was posted to lactnet and
she has shared privately so you could probably access this. Do not hesitate
to advise mother to provide supplemental milk (hers pumped, donor, formula)
if baby is underweight, low production, etc -- don't wait a few more days
i.e. "give it more time" if the presentation shows you calories are needed
- is my humble advise.

Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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