Tricia
My experience, as opposed to research, is that
the paediatricians of the prem babies I used to
work with liked a gain of roughly 20g/day for the
smaller pre-terms - <1500g. But if born over
that weight they liked a gain of 30g/day (1 oz a
day). The UK charts, based on the WHO charts,
which _are_ based on research :-) confirm that a
gain of at least this much is expected (ie seen
as normal) for late pre-terms. See
UK-WHO Growth chart for boys, includes pre-term weights
<http://www.rcpch.ac.uk/system/files/protected/page/A5%20Boys%20UKWHO.pdf>http://www.rcpch.ac.uk/system/files/protected/page/A5%20Boys%20UKWHO.pdf
UK-WHO Growth chart for girls, includes pre-term weights
<http://www.rcpch.ac.uk/system/files/protected/page/A5%20Girls%20UKWHO.pdf>http://www.rcpch.ac.uk/system/files/protected/page/A5%20Girls%20UKWHO.pdf
If a premie is stable and healthy, but gaining
less than this, then the baby's breastmilk intake
needs to be increased - ie from 150-180ml/kg/day
up to as much as 300ml/kg/day. The paeds I
worked with would increase the EBM in 30ml/day
increments, ie from 180ml/kg/day to
210/ml/kg/day, then to 240ml/kg/day etc. It is
not necessary to give formula or other milk
supplements or fortifiers to achieve a better
weight gain, nor to play about with the
fat/calorie content of the EBM - simply feed
_more_ ordinary breastmilk. So easy, so natural,
so normal, so nutritionally suited to the pre-term infant!
Pamela Morrison IBCLC
Rustington, England
-----------------------------------------------------
Date: Sat, 26 Apr 2014 12:15:14 -0700
From: Tricia Shamblin <[log in to unmask]>
Subject: premie weight gain issues
I have a question about this topic also. Does
anyone know of any research about what is
concerned to be "normal" weight gain for
breastfed late preterm infants? Also, if there is
any research about premies and normal weight gain
when mothers are on methadone. My theory on late
preterm babies is that breastmilk is not designed
to rapidly increase muscle mass and fat stores at
first, but instead helps with lung maturity,
immune protection and brain growth and then
begins building fat stores later. Any research to
back that up? Also, any info on late preterm
weight gain when mother is on methadone? I once
had a patient that was stable on methadone
treatment for 2 years, exclusively pumping for 36
week infant. Day 1 - 5# 1 oz, lowest weight 4# 13
oz at day 4, at day 9 was 5# 0 oz, and MD wanted
formula supplementation due to slow growth.
Infant was overall stable and withdrawal symptoms
lessening, and I was happy with rate of growth
and improvement in infant. If anyone can point me
to any research about normal weight gain rates in
late premies, and/or infants of mothers on
methadone I would appreciate it. In the hospital,
it seems that we have some contributing factors
for high rates of formula supplementation in
these babies: 1. Staff are used to rapid weight
gain with formula 2. Staff feels that rapid
weight gain is a sign of improved health 3. Rapid
weight gain equals early discharges and thereby
less work for staff My theories are meaningless
to staff though without research to back it up.
Any info would be appreciated. I have an
opportunity to talk to some of the MDs soon.
Thank you very much, Tricia Shamblin, RN, IBCLC
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