Mary

It sounds like progress is being made with feeding these previously very
prem twins.  I have worked with lots of VLBW and prem babies who have never
had a bottle (and never had fortifier for that matter either).  The
protocol is to breastfeed as many feeds as possible (probably 3 hourly if
the babies are an effective 35 weeks CGA), and then top up with EBM to the
quantity required by each baby (180 - 220ml/kg/day divided by 8 for
3-hourly feeds).   The top-ups would either be given by NGT, or more likely
by cup for babies of this "maturity".  Top-ups would be reduced as each
baby became more proficient at breastfeeding.

The babies I worked with would be discharged from hospital if they were 34
weeks CGA, if they weighed 1800g and if they were exclusively breastfed (or
rarely were still being topped up with mother's own EBM as well).  Weight
would be checked weekly after discharge and the paediatricians liked a gain
of at least 180 - 200g per week, preferably more.  Note:  this was achieved
with mother's own milk exclusively, and no fortifier ever!

Pamela Morrison IBCLC
Rustington England, formerly Harare Zimbabwe.
-------------------------------

PTP: Looking for some suggestions for a mom who wants to exclusively
breastfeed (no bottles) her premature twins.  They are currently 56 days
old, born at 27 weeks gestation.   They are pg feeds with occasional good
feedings at the breast - getting stronger each day.  Mom is pumping plenty
of breast milk, and the pg feeds are mixed with fortifier.   As the babies
begin to move towards more breastfeeding, and ng tubes are removed, would
it be possible to provide the fortified breast milk with an SNS?   Has
anyone worked with VLBW preemie twins that never had a bottle?
Any help appreciated.

Thank you,

Mary
Mary Foley RN, BSN, IBCLC
Lactation Program Coordinator
Melrose-Wakefield Hospital
Melrose, MA 02176

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