Brenda,
Evidence-based practice supports the notion to supplement based on volume of
intake taken at the breast.  I'd recommend this mom rent a BabyWeigh Scale.
It's the only way she's going to supplement accordingly.  Otherwise, without
ongoing testweighing per feeding, it's a matter of a guessing game for
determining how much to give the baby.  Hunger cues and cues of satiation are not
accurate indicators for determining how much to supplement.  Determining a certain
amount of supplement such as 50-60 cc's after each feeding at the breast is
also not accurate.   What if the baby takes 40 cc's at the breast and then mom
tops off the feeding with an additional 50-60 cc's?  The top-off with the
supplement wasn't necessary.  Whereas, if pre/post testweights reveal baby took 10
cc's at a feeding, then supplementing is necessary.  Though not fool-proof,
I'd determine fluid needs of baby and then go from there with counseling mom as
to how much to supplement per feeding based on accurate measurement of volume
of intake taken at the breast.

This is the research-based method for continued follow-up for the preterm
infant after discharge from the hospital.   And as some of us have recently said,
this mom needs lots of support once home to optimize her ability to
exclusively breastfeed her infant.  Like preterm infant weights that often times
fluctuate up and down, the feedings may also fluctuate up and down during the course
of the next few weeks.  Some days this baby may take quite a lot at the
breast, and other days, the baby may not seem interested and have a poor intake.
But, establishing a good repoire with the mom so that you can guide her and
encourage her by showing her the consistent pattern of the baby increasing its
volume at breast over the course of several days or weeks is necessary for her
to achieve exclusive breastfeeding.

Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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