Possible feeding issue/solutions for preemie/nicu babies

[lilysmama1124]

I am scheduled to have a c-section thursday to deliver my twin girls at 36 weeks. I have marginal vasa previa so have to have the c and they don't want me to go much past 36 weeks. I have had steriods much earlier in the pregnancy when we worried about twin to twin transfusion. My biggest concern is feeding issues. I had no nursing issues with dd1 born at term so I don't know much about problems that might arise or what they may want me to do at the hospital. Just looking at posts here it seems there is something called human milk fortifier and something called neosure or preemie formula. What is the difference? What are the options if I need to supplement? What are legit/valid reasons to supplement if I am able to pump enough bm. Are there times when they may want to supplement that aren't legit? My problem is that as a natural minded mama (no-vax, exclusively bfed dd1....) who doesn't neccessarily trust that protocol at the hospital is always the best course I don't want to just agree to everything they want to do in the nicu just because I have preemies but I also understand that there may be legit medical reasons for me to do things that don't seem right to me.

[ArcticRose]

I didn't want my baby to have the fortifier but they talked me into it. Knowing a little more about it, I would be more adamant in my refusal.

Your babies are a little older than mine was (32 1/2 weeks) so it may not be as much of an issue for you to refuse.

My DD started spitting up and got constipated after they started adding the fortifier. The idea is that it adds calories so the baby puts on weight faster, but, I believe, that the spitting up and constipation used more calories than the fortifier added.

I don't believe the fortifier does enough good to be justified... but I'm not a medical professional.. just a mom with an opinion. I followed my instinct once I got home and didn't give her fortifier any more. She stopped spitting up and her constipation went away within a week.

Congratulations on your two little ones!

[sbrinton]

With 36 weekers, I would do everything you can to try to go straight to breastfeeding on-demand. If they are breathing well and able to latch on, you may be able to completely avoid bottles and fortifier.

With our 35 weeker who was 5 lb 8 oz, we went straight to breastfeeding. He was a patient and determined little guy (still is!) and he did great with just breastmilk.

With our 31 weeker who was about 3 lb 9 oz, we started with an IV/PICC line and when he was a few days old he began to get breastmilk (I was pumping like crazy!) through an NG tube. We had the NG tube placed through this nose (not mouth) as this helps to prevent oral aversions. We also started kangaroo care with "practice" breastfeeding as soon as he was stable. At about 33 weeks he began to latch on well, by 34 weeks he was getting almost all of his feeds by breast. At that point, we took out the NG tube and let the NICU give him 2 bottles a day fortified with HMF and then neosure.

HMF is only available at the hospital and neosure can be bought commercially. HMF is more concentrated than neosure and is typically used with smaller babies. There are some good reasons to fortify, especially for babies who are very small or not growing quickly.

When we went home with our little one, we went straight to exclusive breastfeeding. He has grown really well (9 months old now), but we're still dealing with anemia. We fought a lot with our docs about polyvisol, but his iron levels are still low at 9 months, so...sometimes there is a good reason to suppliment.