what issues am i looking at probably

[mom2tig99Nroo03]

if baby comes now at 34 weeks?

what about next week? i know it'll be by 37 weeks at the latest when he is born, i am already trying to make preparations for feeding issues, (even my 41 weeker had a mouth too small for my short wide nipples) and am guessing there could be breathing problems. i received steroids wednesday and thursday, so hopefully they'll do him some good.

what else should i prepare for?

[DocsNemesis]

It can vary so much. At 34 weeks he'll probably be ok with breathing, since you had steriods. Might need a canula, at least for awhile, but thats non-invasive. Preemies often have apnea and thats why mine was on a canula for so long (and he was a 33 weeker).

I dont know if they'll put him straight on food by mouth at first. My ds had a gastric tube and then was gradually switched to bottles. I got him on the breast at home on his due date. (It actually didnt take much work, I offered it once a day, and then one day he just latched on and nursed away; he went off of bottles all together within a couple of days) They also mixed one scoop preemie formula with my milk until he got home and I took him off. It resulted him in eating more (that along with offering the bottle whenever he wanted it, versus a schedule like they had at the hospital) and actually gaining weight faster.

Also expect him to have jaundice and be under bili lights since most preemies have a hard time with getting rid of the bilirubin. It might not happen but be prepared.

The last thing I can think of is that he needs to be able to maintain his own body temp before he can go home. He might not have that issue either, mine didnt, even being earlier. It just all varies so much.

Keep in mind too that holding/kangaroo care is soooo good for them and will get him home faster.

I cant think of anything else atm. Hopefully he'll do really well!

ETA: also, if you end up being further along, these things get even less likely. Many 35 and 36 weekers go straight home and at 37 weeks, I'd be surprised if he needed a NICU stay. I would imagine apnea and getting them on the breast (and possibly jaundice?) would be the biggest issues with a 35/36 weeker. I could be wrong though.

[true2Him]

I agree with pp. My firstborn was 34 weeks, and my second was 32 weeks. Weight was one of the primary factors ( 3lbs 11oz and 3lbs 8oz). She had bili lights (was so nosy, she kept try to move her the thing protecting her eyes when she heard me talking), incubator to warm her until she maintained her temp and didn't really need much for breathing or anything. Her first meal was formula. (I didn't know they fed her.)

The thing that frustrated me was that I wasn't given proper instructions on pumping milk and storing it, so my first couple tries were tossed out. I had absolutely no idea that so little would come from all my hard work using that machine!

She might have come home sooner if I hadn't expressed concern about other issues, but she was released in 12 days. I talked and sang to her a lot....maybe that's one of the reasons she likes to make up songs.

[mom2tig99Nroo03]

thank you for the info. our local hospital sends babies who have any kind of breathing issues at all to a hosp 2 hrs away because they're just a basic nursery here. they're not equipped to deal w anything more than jaundice pretty much.

[DocsNemesis]

Wow, really? They wont even use a canula?

Well, hopefully with the combo of the steriods and your gestation, there wont be any breathing issues.

[mom2tig99Nroo03]

nope- the doc said any breathig issues go to charleston. i know they *can* do stuff here- they just don't keep them here once it is done. if they think in labor that baby will need much, they have the nicu ambulance team come down and stand by while mom is in the hosp. laboring. if mom is not a bare minimum of 34 weeks, mom is transported while pregnant in the nicu amb.

[Lousli]

I read on another thread that your baby has arrived safely and that you both are doing well. Congratulations! I look forward to pics and updates when you can. All the mamas here are wonderful if you need support navigating the NICU.

[tbavrbab]

Aww momma, I had hoped nobody in our DDC would end up over here. I'm VERY glad to hear your little one is doing okay though!!

Best wishes and congratulations on your little one!

[mom2tig99Nroo03]

Originally Posted by DocsNemesis

It can vary so much. At 34 weeks he'll probably be ok with breathing, since you had steriods. Might need a canula, at least for awhile, but thats non-invasive. Preemies often have apnea and thats why mine was on a canula for so long (and he was a 33 weeker).

I dont know if they'll put him straight on food by mouth at first. My ds had a gastric tube and then was gradually switched to bottles. I got him on the breast at home on his due date. (It actually didnt take much work, I offered it once a day, and then one day he just latched on and nursed away; he went off of bottles all together within a couple of days) They also mixed one scoop preemie formula with my milk until he got home and I took him off. It resulted him in eating more (that along with offering the bottle whenever he wanted it, versus a schedule like they had at the hospital) and actually gaining weight faster.

Also expect him to have jaundice and be under bili lights since most preemies have a hard time with getting rid of the bilirubin. It might not happen but be prepared.

The last thing I can think of is that he needs to be able to maintain his own body temp before he can go home. He might not have that issue either, mine didnt, even being earlier. It just all varies so much.

Keep in mind too that holding/kangaroo care is soooo good for them and will get him home faster.

I cant think of anything else atm. Hopefully he'll do really well!

ETA: also, if you end up being further along, these things get even less likely. Many 35 and 36 weekers go straight home and at 37 weeks, I'd be surprised if he needed a NICU stay. I would imagine apnea and getting them on the breast (and possibly jaundice?) would be the biggest issues with a 35/36 weeker. I could be wrong though.

his bili peaked right before the level he would had to go under th elights, breathes well on his own, his big issue id the feeding, i'm not even tryign once a day, as even with bottlefeeding it takes him a long time to eat. he was doing well until last night's weigh-in. he lost almost half an ounce between the time he was weighed friday night and last night he pulled his own ng tube out and they are not putting it back since he has had more than 4 hrs of feeds.

he did pass his hearing and carseat test, so if we get this feeding issue taken care of he can come home. we did get transferred back to our local hospital at least, so we r closer to home.

he is receiving my pumped milk with human milk fortifier. i'm almost afraid to ask what is in it, since i know his poos don't smell as mild as my other full term babies did.

the dr was in y'day and was sayoing that hmf is hard to get so they'd probably have me add neosure powder to use as a fortifier. i am not sure what to think about this.

[tbavrbab]

Yes, it's almost definitely Neosure if you do not specifically ask for or demand HMF (human milk fortifier).

As for feeding issues, I don't have much help here. For Adara (my 33w HELLP baby), going straight to the breast was better for her eating. She FOUGHT bottles hard, and it became a major issue for her. I often wonder if it was the Neosure that turned her off to bottles, but it could be I just have funky milk after it's been refrigerated or frozen. She ate and gained better at the breast. We dropped the Neosure as soon as we left the hospital, with the agreement between my husband and I that if she slowed down or stopped gaining we would add it back.

My son was born at 34w nearly 35w and he had no issues (a little trouble with jaundice, but the doctors recommended a certain length of sun exposure each day) and came home right away. I know now that is not typical for his gestation, but he had major issues after coming home. Nothing that ever required hospitalization though. We're just *still* trying to figure out what is wrong with him (over 6 years later).

HELLP can be rough on both you and your little one. Also, feeding issues are the longest and hardest part of going home. It's the last thing that babies get ready for, even after breathing, so it's not too surprising that is the issue you are having. Try lots of different things. Maybe a slower flow bottle or a faster flow, or try nursing, or try SOMETHING different. Maybe you'll find what "clicks" for him??

I hope this time goes quickly for you. I've had you in my thoughts a great deal lately.

[DocsNemesis]

I agree with the neosure thing. My ds wouldnt eat very well until we came home and I stopped using neosure (and started letting him eat on demand-even though it was bottles at the time, with boobie milk). Suddenly his weight gain went crazy. I think the neosure upset his tummy (he spit up a lot) and the scheduled feedings were a negative for him.

As far as breastfeeding goes, I know its hard, but trying at least once a day helps keep the idea going, and it might actually be good for your production. I HATED trying to nurse in the hospital, to a point that I gave up. But as soon as we came home, I was trying daily to nurse him...without any luck. And then-surprise!-on his due date he latched on like a champ and never looked back.

Also, sorry you had HELLP Did you have a cesarean? I know how HELLP feels and it really drains you. I'm glad you made it to 34 weeks at least and that baby is doing well!!!

[sbrinton]

Our 35 weeker was able to exclusively breastfeed from the beginning. Our 31 weeker began getting breastmilk through a gavage tube. After the first week, this was fortified with HMF. Later they switched to neosure, with the idea that we would use that at home.

As far as learning to breastfeed, we began by holding Zephan during his feeds skin to skin and "practicing" while he got milk through the tube. This meant licking, smelling, suckling a little. When he began to latch and I could feel him getting a little milk, we would start the feeds by breast and finish with the tube (weighing him before and after he breastfed to see how much he was getting). We decided to wait to introduce bottles at all until breastfeeding was well established. He went from having just a few cc's by breast 2-3 times a day to having full feeds by breast 5-6 times a day in about a week between 33 1/2 and 34 1/2 weeks. We did use a nipple shield until around his due date.

In the hospital, we argued and tried to not use the HMF and the neosure, but eventually decided it wasn't that big of a deal and focused on just doing what we could. Zephan would only take about 35-40cc of milk fortified with HMF by bottle, while he would take sometimes more than 60cc by breast, so the neonatologists said (eventually!) that he was breastfeeding well enough that he wouldn't need the neosure at home.

He's 9 months old now, still happily breastfeeding and almost 5 times the size he was at birth!

Anyway, I would encourage you to try breastfeeding more if you can! I would try 2-3 times a day at least, and hopefully work up to at least 5-6 out of 8. There is lots of research out there suggesting breastfeeding can be easier for preemies (it's easier for them to control the amount of milk so they do not gag, their heart rate, breathing and O2 saturation is better). Anecdotally, our preemies had a much easier time with breastfeeding than bottlefeeding.

[mom2tig99Nroo03]

ty all!

we're trying, but for us it isn't a flow problem at the breast, because i can do both- either pump off enough for the flow to be real slow or i can not do so and he wouldn't have to even work for th emilk at all, but he does have to actually latch on and suck! for us the problem is the shape of my nipples is nothing like a bottle nipple. my dd is the only one who never had issues latching to me- and that is beause she latched on well at birth and did not have any bottles.

no c/s- just a much more rapid induction than i thought i could handle since i was stuck in bed unable to change positions etc to work w contrax.

[Lousli]

Can you have a lactation consultant meet with you? Sometimes the hospital ones aren't the greatest, you might actually want to ask LLL or look in finding your tribe for a good local person. Ask for someone who has experience with preemies. I ended up using a nipple shield with both my girls (36 and 33 weeks) because of the smallness of their mouths/shape of my nipples/size of my breasts/and for the younger one, because she was used to a bottle from the NICU.

My older daughter weaned off the shield after about 2-3 weeks and nursed like a champ until 4 years. My younger one took 3 full months to really learn to nurse without needing a bottle to help fill her up or the nipple shield for proper latching. However, once she learned, that was it, and she's still nursing at age 4.5 (which sometimes makes me feel more like this : than this : if you know what I mean, but I'm still glad I persisted.)

[sbrinton]

Based on the issue you are having, I would really suggest trying a nipple shield. They make it much easier for a small baby to latch on and they come in different sizes.

[lilysmama1124]