Although I work in a facility with a level 1 nursery, we often have 35 
weekers. They are sometimes difficult because their levels of maturity can 
vary widely.

First, I want to agree that I think 45 minutes-1 hour/feed is too long for 
this type of preemie. This baby is spending an inordinate amount of time 
trying to feed (and not necessarily efficiently)and is probably using up 
valuable calories in the process. I have learned from one of the 
specialists around here that a premature (or underweight baby) will NOT 
feed well unless they gain weight and have the energy to brestfeed 
efficiently. So, in this case, I think the long feeds may be contributing 
to the lack of an acceptable weight gain.

This mother should be encouraged to pump (even if her supply is adequate 
whichis probably is). She shoudl concentrate on building her supply while 
letting the baby practice at breast. Then if her milk can be given with 
fortifier (yes, maybe by bottle)the baby is lkely to gain faster, have 
more energy and be discharged sooner.

If this baby goes to breast already and Mom is motivated, baby will 
probably transition easily to breast when it has the energy and physical 
strength to do so.

It doesn't sound as though the NICU nurse weighed the baby properly  for 
that pre/post weight, but we don't really have the facts. They should be 
looking at gram weights, anyway. Are they? She should make sure of that.

I have followed a couple of 35 week babies in the community and I was in 
one home for 5 weeks until that baby really got it together. It is not 
going to happen overnight. 

At this stage of the game, I feel that MOM should pump to keep herslef 
stimulated and to have a good supply, let the baby practice often but for 
shorter periods of time, and juts let the baby be fed her milk as easily 
as possible. If that baby can keep from using too many calories at breast 
at this juncture, I feel the baby will probably go home sooner.

Remember, the goal is to get as much breastmilk into this baby as possible 
to assure optimal growth. With that growth will come the strength to get 
her milk directly from the breast.

Betsy Riedel RNC, IBCLC
Connecticut  

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