Case Study: Successfully Breastfeeding the Premature Infant

Melissa Nash, MPH, RDWashington County Field Team

NICU info Bryan is an ex-31 wk premie No major complications in NICU Discharged at 36 wks CA Mom had great milk supply in the NICU: Pumped 6 oz q 3 hrs Discharge meds/vits:

No meds & 0.5 MVI w/ iron Discharge feeding plan:

EMM + EnfaCare to 22 kcal/oz

38 wks GA (RD Home Visit)Feeding history:

Mom has been BF q feeding. Usually offers fortified bottle before BFSometimes pumps after BF

Good wt gain since discharge: ~1 oz/d

Bone labs normal in NICU:Ca 10.6, Phos 6.4, Alk Phos 412 (all

normal)

Gives 0.5 ml MVI w/ iron

38 weeks GA (RD Home Visit)Nutrition Plan:

Continue to BF q feedingOffer breast before bottle Always pump after BF (or every time

baby eats) Continue to fortify all bottles to 22

kcal/ozChange to 1 ml MVI w/ ironOrder bone labs (to be checked 4-6 wks

post-discharge)

40 wks (MD appt)

Bone labs drawnAlk Phos 498 (slightly high)Ca 9.2No Phos drawn

Nutrition Plan:Re-ck labs in 1 mo - at next MD apptContinue w/ same feeding plan

1 wk CA (Home visit by CHN)Weight check:

Excellent wt gain: avg 1.8 oz/d x 3 wks

Feeding history:BF ~10-15 min. q feeding1-2 oz fort. bottle of EMM to 22 kcal/oz q

feed.Pumping q feeding

Nutrition plan:Night = EBF (no pumping/bottles)Day = BF + fort. bottles + pumping

Growth Grid

1 month CA (WIC appt)Weight check:

Avg 1 oz/d x 3 wks

Feeding history:EBF at night (no pumping/bottle)EBF 2-3x/day Offers breast + fort bottle 2-3x/day

Nutrition Plan:Start EBFContinue w/ 1ml MVI w/ iron

1 ½ months CA (out-pt RD appt)Weight check:

Avg 1 oz/day

Feeding history:EBF

Nutrition Plan (no changes):Continue EBFContinue 1 ml MVI w/ iron

2 mos CA (MD appt)Bone Labs:

Alk Phos 669 (H), Phos 5.4, no Ca

RD Home VisitPlan/Options (MOB chooses):

1. Offer 2 bottles/d of straight EnfaCare (mom to pump & freeze milk)

2. BF + fortified bottle + pumping q feeding3. Continue to EBF + start Tribasic

2 months CA (RD Home Visit)Start Tribasic (Ca/Phos Suppl.)RD to provide specific instructions to MD:

MD calls Rx into compounding pharmacyDosage 1/8 tsp powder BID x 6 wksRe-check bone labs in 4-6 wks

RD to provide specific instructions to family:Parents to buy Tribasic out-of-pocket,

~$25-30Parents to buy 1/8 tsp measuring toolMeasure powder & mix w/ ~5ml breastmilk Give via syringe or infant spoon

3 ½ months CABone Labs:

Alk Phos 403, Phos 5.5, Ca 10.2, Hgb 12.2 (all normal)

Nutrition plan (no changes):Continue EBFContinue w/ Tribasic 1/8 tsp BIDContinue 1 ml MVI w/ iron

4 ½ months CABone labs:

Alk Phos 372, Phos 6.0, Ca 10.6 (all normal)

Nutrition Plan:Stop TribasicContinue EBFContinue 1 ml MVI w/ ironDelay solids until 6 mos CA