This is quite a complicated case.  A pediatric nutritionist should be
involved.

The predominant reason for low gain, no gain, or weight loss is not enough
calories. A different reason would be a metabolic or genetic syndrome, for
example he has "as yet unexplained sodium deficiency."  With the problems
this baby has experienced, this is a possiblility, in my opinion, and I
presume baby is under good care and this is being looked into / ruled out.

However, just on a rough estimate of his weight, he is below the volume he
would need to gain and grow. So I think the biggest problem is not enough
volume (125 mls q 3?). If he physically cannot take in more volume, then it
seems he will need more calories in a smaller volume. There are different
ways to do this, mother should be provided with reasons/risks and make an
informed decision.

Can he be fed more frequently? Can he be given more volume by G-tube?

The recent weight gain, if he has not been taking more volume in, would
worry me - "gained 125 grams in a 24-hour period." Could this be fluid
gain, and a sign of too much sodium or cardiac problem?

The next concern is mother's milk production. She will need much support. I
recommend rental pump, hands on pumping, eat well, galactagogues.

Laurie Wheeler, RN, MN, IBCLC, RLC
Mississippi Gulf Coast USA

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