Hi, all -

I've been no-mail for several months, and miss the lactnet give-and-take
every single day. I'm trying to spend less time with my computer, and more
with everything else in my life, so will stay no-mail for now, EXCEPT:

Here's my question: do we really *know* what a premie baby's growth rate
"should" be, especially once the baby is over 2000 gm. and past its
estimated due date?

I'm working with a mother of twins whose babies were born @ 33 wks, around 4
lb. each. They are now 7 wks old, both weighing around 6 lbs,  so just round
about 40 wks. gest age. When I calculated their rate of gain - which I did
from their birthweights, not their lowest wts because I didn't know what
those low wts were - they are both just a teeny bit under what they would
weigh at the lower end of the "normal" gain rate of 4 oz/wk. This strikes me
as not bad at all, considering that they look and act very good - both are
spunky, learning to nurse quite well, getting only a small amt. of
supplement, and generally look to my eye to be doing well. They are
improving in the strength & skill of their suck, and have remained happy to
nurse frequently. Mom does well with them, wants to boost her supply - not a
real big problem there, she's definitely on the right track.

The pedi wants the babies to be gaining faster - she wants to see 8 oz/wk.
Well, who wouldn't? This isn't really a conflict, but I got to researching
what we really know about what the babies "should" be gaining at this stage
of the game, and all I could come up with is that we don't know much about
it once they are at this stage. I have no doubt at all that these babies
would gain faster if we poured in more supplement - but I do question how
much is known about the relative advantage of a more rapid rate of gain vs.
the potential hazards of tipping the balance by interfering with the
"normal" nsg process (adding more formula supplement, keeping the babies so
full that they become too sleepy, having them potentially nurse less at
breast, etc.). Do we know that there is a long-term advantage to a more
rapid rate of gain in these circumstances?

Thanks to anyone who has any research citations or can point me towards more
definitive info on this. I have a real opportunity at hand here to not only
increase my own knowledge, but to share info with a good BF-friendly
physician who I think is at least as much in the dark on this as I am.
Please answer privately as well as to list. Love to you all - I miss you!

Cathy Bargar, RN,  IBCLC Ithaca NY

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