Transcript 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:
 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 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
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 postdischarge)
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
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
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 EBF
 Continue 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 EBF
 Continue 1 ml MVI w/ iron
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
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
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
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