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
Top Related