Hi Esther,

Welcome back to lactnet!

You are asking some very good questions re increasing the amount of breastfeeding or breastmilk feeding for this little one.

I am not trying to be elitist, but if you have never taken care of such a baby (for 9 mos and 13 mos I have, and many more), it is a very difficult, frustrating, and

complicated experience, as you can imagine. To review your case, the baby was born at 24 wks, is leaving hospital at 6 mos (2 mos corrected age), and has short gut (possibly from NEC and bowel surgery???).

Most everyone on the team will be wanting to use breastmilk. We know all the reasons why. You said that on breastmilk the baby was stooling out and losing

nutrients. These babies usually have ostomies which are very difficult to fit and adhere to their little bodies, and the stool is very excoriating to their abdominal skin.

(Hopefully nowadays there are better products for this).

It does sound like the doctors are planning for more breastmilk in the future. What I suggest is to support mom for continued bf and expressing. You may want to do a little research on lactoengineering, as you said ala Paula Meier's work at Rush Presbyterian re giving hindmilk. Once you have some info, you may wish to share with mother or doctors re trying the hindmilk and assessing baby's response. Since baby is on Elecare, I'm not sure if other artificial milks had been tried, and baby is sensitive to some proteins. Therefore mother may wish to eliminate common food allergens, as that may have contributed to the baby stooling out on ebm.

This baby will likely continue to have feeding difficulties for a time.

Laurie Wheeler RN MN IBCLC

Mississippi USA





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