Preemie that Only Tolerates Breast Milk.

justjenny · May 22, 2008

I think you already answered my suggestion. Our lactation consultant spins down the milk to determine caloric content....but I believe she also spins down hindmilk so to further concentrate it when feeding to baby (24+ cal ideally)

You didn't answer the question what is the baby feeding per kilo?? How often?

Also, specifically how does the baby not tolerate feeds with fortifier? Sometimes it is just a matter of changing how the feeding is administered. (ie: a kid who doesn't tolerate a gavage feed over 15 min may tolerate over 45 min...or even a continuous fdg. If the baby is nippling and very "spitty" is the baby swallowing too much air or something with the way the fdg is being given? Or instead of nippling Q3 or Q4 how about smaller volumes Q2??

The more information that you could give on the specific issues could actually help you out.

:twocents:

Jenny

sunny17 · May 23, 2008

I think you already answered my suggestion. Our lactation consultant spins down the milk to determine caloric content....but I believe she also spins down hindmilk so to further concentrate it when feeding to baby (24+ cal ideally)
You didn't answer the question what is the baby feeding per kilo?? How often?
Also, specifically how does the baby not tolerate feeds with fortifier? Sometimes it is just a matter of changing how the feeding is administered. (ie: a kid who doesn't tolerate a gavage feed over 15 min may tolerate over 45 min...or even a continuous fdg. If the baby is nippling and very "spitty" is the baby swallowing too much air or something with the way the fdg is being given? Or instead of nippling Q3 or Q4 how about smaller volumes Q2??
The more information that you could give on the specific issues could actually help you out.
Jenny

The baby will be getting 48 cc every 3 hours when she gets back to full feeds.She's been gaining tremendous weight on TPN/lipids since this last trial of formula, so we know she can gain weight when given the right nutrition. She does not tolerate fortifier or regular preemie formulas at all. Her belly blows up, she ends up back on cannula, she has tons of air and loops in her belly, and she stools extremely heme postive stools with mucous/tissue. Her H/H drops, and her color turns form pink to gray. Overall, she becomes sick quickly and her whole body responds.

It really has nothing to do with how she is feed, ie how often or the amount, but more what she is eating. She loves to nipple, which is what is so sad because due to the trial and error of all of this, she has been on stop and go feeds a million times.

We will be trialing the prolacta with her and I guess if that doesn't work they may consider trialing Aliementum or Neocate.

SteveNNP, MSN, NP · May 23, 2008

Sounds like a candidate for Elecare/Alimentum/Pregestemil/Neocate/Isomil......

babynurselynn · May 23, 2008

Our hospital did a study using Prolacta with good results. The Prolacta was tolerated and did allow the babies to grow within normal breastfed baby tables. The downside is that it is expensive, however, keeping the baby in the hospital for failing to gain weight is even more expensive!

sunny17 · May 23, 2008

BabyNurseLynn,

Thanks for your response, is there anyway you could get me that study? I would greatly appreciate it:)

babynurselynn · May 24, 2008

If you can give me until Tuesday, I can probably line you up with the study--or at least the company rep that we worked with for the study.

sunny17 · May 24, 2008

Thanks,

That would be great! :bow:

sunny17 · Jun 3, 2008

Just an update.....

This little peanut has turned the corner! We had the mother's milk analyzed and it was only 17 calories!! That explains the weight gain issue. Over the past week her intake has really gone up, taking 80 + cc at each feeding, and she is gaining good weight! Our docs feel that she is making up for the low calories in the milk, but taking such large amounts. We never had to use the other products and she is going home sometime this week!:loveya:

It amazes me how kids make a complete turn-around like this.

Thank you all for your help and suggestions and I still would love a copy of that Prolacta study if you have it!

babynurselynn · Jun 3, 2008

Glad to hear the good news on the baby! Sorry it took so long to get back to you, but I was SEARCHING for the study results! I spoke with our research nurse and she is trying to find out if it has been published yet. I'll give you the names of the researchers so you can look it up later if it isn't published yet.

TITLE: Prolact-Plus, a human milk-based fortifier, testing in a multicentered, open-label, cohort trial.

Principal investigator: Carolyn Rich-Denson, MD; Neonatology, Intermountain Health Care

Investigators: Ronald D. Stoddard, MD., Cheryl A. Miner, RD, Larry D. Eggert, MD, Constance Valentine, RN, Susan Wiedmeier, MD, Jill Burnett, RN, Robert Christensen, MD.

Hope this helps in the future.

corks · Jun 3, 2008

We try half EBM and half low birthweight formulas (LBW). We start with the EBM and then give the LBW on top. We don't mix the two in the same bottle. Then we would try progestermil and finally as steve said Soya. Has the babe been investigated e.g pH studies?

We had a babe like yours recently, turned out to be pyloric stenosis. Good luck,sometimes these pucky babes need several experimental feeding regiemes before you crack it. lets us know how it goes:up:

corks · Jun 3, 2008

Sorry, my last thread is behind the times, read the first page of replies and did not realise that the babe had turned the corner.Having several senior moments today!!!!!H Good News about babe:yeah:!!!!!!!