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Case Study: Successfully Breastfeeding the Premature Infant

Case Study: Successfully Breastfeeding the Premature Infant. Melissa Nash, MPH, RD Washington 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:

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Case Study: Successfully Breastfeeding the Premature Infant

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  1. Case Study: Successfully Breastfeeding the Premature Infant Melissa Nash, MPH, RD Washington County Field Team

  2. 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

  3. 38 wks GA (RD Home Visit) Feeding history: • Mom has been BF q feeding. • Usually offers fortified bottle before BF • Sometimes 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

  4. 38 weeks GA (RD Home Visit) Nutrition Plan: • Continue to BF q feeding • Offer breast before bottle • Always pump after BF (or every time baby eats) • Continue to fortify all bottles to 22 kcal/oz • Change to 1 ml MVI w/ iron • Order bone labs (to be checked 4-6 wks post-discharge)

  5. 40 wks (MD appt) Bone labs drawn • Alk Phos 498 (slightly high) • Ca 9.2 • No Phos drawn Nutrition Plan: • Re-ck labs in 1 mo - at next MD appt • Continue w/ same feeding plan

  6. 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 feeding • 1-2 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

  7. Growth Grid

  8. 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 EBF • Continue w/ 1ml MVI w/ iron

  9. 1 ½ months CA (out-pt RD appt) Weight check: • Avg 1 oz/day Feeding history: • EBF Nutrition Plan (no changes): • Continue EBF • Continue 1 ml MVI w/ iron

  10. 2 mos CA (MD appt) Bone Labs: • Alk Phos 669 (H), Phos 5.4, no Ca RD Home Visit Plan/Options (MOB chooses): 1. Offer 2 bottles/d of straight EnfaCare (mom to pump & freeze milk) 2. BF + fortified bottle + pumping q feeding 3. Continue to EBF + start Tribasic

  11. 2 months CA (RD Home Visit) Start Tribasic (Ca/Phos Suppl.) RD to provide specific instructions to MD: • MD calls Rx into compounding pharmacy • Dosage 1/8 tsp powder BID x 6 wks • Re-check bone labs in 4-6 wks RD to provide specific instructions to family: • Parents to buy Tribasic out-of-pocket, ~$25-30 • Parents to buy 1/8 tsp measuring tool • Measure powder & mix w/ ~5ml breastmilk • Give via syringe or infant spoon

  12. 3 ½ months CA Bone Labs: • Alk Phos 403, Phos 5.5, Ca 10.2, Hgb 12.2 (all normal) Nutrition plan (no changes): • Continue EBF • Continue w/ Tribasic 1/8 tsp BID • Continue 1 ml MVI w/ iron

  13. 4 ½ months CA Bone labs: • Alk Phos 372, Phos 6.0, Ca 10.6 (all normal) Nutrition Plan: • Stop Tribasic • Continue EBF • Continue 1 ml MVI w/ iron • Delay solids until 6 mos CA

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