Libby,

Sometimes the calorie count of the expressed milk (or formula) will be increased above the "normal" (we all know there is a range not a 'normal') to facilitate growth while restricting fluid.   Fluid restriction can be critical for some cardiac problems.

Other possibilities might include test weights pre and post and feeding. Direct feeding via a SNS at breast at the start of the feed using the skimmed fat layer from expressed mother's milk after it separates or the various oils, concentrated formulas or powdered supplements mixed with breastmilk and  used by NICUs  could keep the baby at the breast.   The choice of the supplement is complicated and will involve consideration of the infants mineral and protein load, not just calories.   With an open and flexible attitude it should be able to be done at the breast, at least partially.

Carla

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