TTN (Twin to Twin Transfusion) premature infants born at 28 6/7 weeks 
gestation now 20 days old. Twin A (recipient) weight at birth1440 gms 
presently 1446 grams. Twin B (donor)at birth 960 grams presently 1130 grams.

Twin A is on room air, in a Isolette(servo) with a 8 Fr NGT. On Po meds. 
MVI, Fe, NACL and Caffeine. Twin B on room air, in Isolette (servo) with 6.5 
Fr NGT. On PO meds MVI, Fe, Nacl and Caffeine. Has periods of transient 
tachypnea. Both twins feed Q 3hrs  per NGTs. Twin A 29 ml EBM /HMF 
24Kcal/oz. Twin B 21 ml EBM/HMF 24 Kcal/oz.

Parents live a distance from the hospital and have 2yo and 5 yo and ill 
mother-in-law. Mother wishes to breastfeed and has been pumping. Fischer 
House has offered to help and hve mother rooom there when Twins are ready to 
breastfeed. Father with watch other children.

My question is what is the best approach /plan to keep her supply up and 
initiate breastfeeding before introducing bottles? Should I start with 
kangarooing, suckling at breast non-nutritive for contact then at 32 wks 
move to 1 X per day nutritive breastfeeding?

No IBC LC at this location

Sincerely,
Patricia Guenther RN

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