Breastfed preemies using same energy as bottlefed

[PatioGardener]

I don't remember seeing this study discussed on MDC - it has great implications for premature infants.

There has long been an argument in the NICU that breastfeeding takes too much energy and therefore premature babies must be bottle fed. This study seems to be a step on the way to disproving that. Resting energy after feeding was no different in bottle fed or breastfed infants, the opposite to what the authors expected when they began the study.

The abstract of the publication can be read for free here:
http://pediatrics.aappublications.or...ct/124/6/e1149

The authors' final conclusion is:

We speculate that it is safe to recommend feeding at the breast for infants born at >32 weeks when they can tolerate oral feeding.

[plantmama]

This is really interesting to me as I was repeatedly told how much breastfeeding tired preemies out. From about 32 weeks on (ds was born at almost 30) I tried breastfeeding in a very low pressure way a couple times a day (skipped days that ds was having lots of desats etc..) and he came home at 36 weeks exclusively breastfeeding. FWIW he had just started this within days of leaving.
The thing is I was sheepish about pushing breastfeeding every day not because I thought ds couldn't handle it but because many of the nurses were really controlling over how much time I spent on it and I hated getting all their sharp comments. Thank goodness we mostly had laid back nurses or it really may have negatively impacted my ability to take ds home exclusively breastfeeding. Hopefully NICUs will pass this study around and implement better breastfeeding education. On days where there was a nurse who didn't like me breastfeeding I often wouldn't try (I was very young and in a really sensitive place emotionally).
Thanks for posting this! Did you post in the NICU forum as well?

[Satori]

I have what may be a stupid question, the smaller they are the smaller there mouths are, those preemie bottle nipples are tiny, how in the world do you manage to get enough breast tissue in there mouth and for them to have the strength to be the milk out?

[sapphire_chan]

Originally Posted by Satori

I have what may be a stupid question, the smaller they are the smaller there mouths are, those preemie bottle nipples are tiny, how in the world do you manage to get enough breast tissue in there mouth and for them to have the strength to be the milk out?

They specify infants who can tolerate oral feeding, so they controlled for the ability to breastfeed at all.

And manual compression of the breast could assist infants who are right on the edge of being able to nurse.

[Heba]

Gosh this is interesting. Thanks!

[plantmama]

Yes, the suck/ swallow coordination doesn't start to develop until at least 32 weeks I believe so until then babies can get their feeding (pumped breastmilk) through a nose or mouth tube. Ds first just had ivs in his umbilical cord. He's 6 now so it's all a little fuzzy. Ds had a feeding tube until maybe 34-35 weeks.
I gather that mouth size can be an issue but some women use nipple shields which help with that I think?

[proudmomof4]

Thank you for sharing, that's good to know.
I've read before that some study found BF is less stressful for the cardiovascular system of preemies than bottle feeding but I don't recall where this information came from.

[elanorh]

Great, wonderful article, thanks for sharing! I just posted a link to the abstract on my Facebook page; I have many friends who are pregnant right now, I hope none of them end up with a NICU experience but if one of them does, hopefully they'll have read and remembered this article.

I always thought intuitively that it shouldn't take that much more energy to nurse - especially since Mom is generating warmth, hearts are syncing their beats, etc.

[felix23]

This is a very interesting study, but it wasn't my experience at all. I was at a very, very pro-breastfeeding NICU and we started letting dd1 be at the breast when she was being tube fed when she was still under 2 lbs. But when she got old enough for oral feedings, breastfeeding just exhausted her. She started losing weight and just in general took a turn for the worse. So we tried bottle feeding and she did great! They gave me a choice of bottle feeding and getting to go home in a couple of weeks or waiting till she could take all food by nursing and not knowing how long that would be. It really took till she was around 5 lbs for her to start nursing well and that didn't happen till two months after she came home from the NICU. I don't regret my choice to bottle feed at all. The feeding tubes seemed to really bother her, so I was willing to do anything to get her taking food by mouth so she would be more comfortable.

I know of other preemie mothers who had the same experience as I, so while it is most likely that breastfeeding will be easier for a preemie, mothers need to be aware and prepared that it isn't always like that.

[boobs4milk]

there re so many factors that go into breastfeeding in the nicu. here is a run-down of what we went through.

1. change baby's diaper

2. take baby's vital signs

3. get a chair and screen

4. unwrap baby and remove or reposition cords

5. remove all baby's clothes for pre-weigh

6. rewrap baby because if her temp drops below 97.7 she gets tube fed

7. latch baby while being 'assessed' for proper handling

8. be reminded every few minutes that you only have 10 mins for baby to get the minimum (2 oz in our case!!!) or baby gets the tube

9. unwrap baby for post-weigh

so, yea no wonder it wears them out to try to bf. there's too many rules!!! i got her to take 22 cc's once while in there and i got told how 'little' that was and it was not a good bf and i probably would not be able to bf her!!!! i was also told that my breastmilk wasn't adequate calories and i would be starving her if i didn't supplement. they were force feeding her 2 oz every 3 hrs because that's the amount she required to have a 1-2 ounce weight gain per day.

we've struggled with latch but we're at 4 mos old and she's been fully BREAST fed since she was 4 weeks. she came home at 17 days old, fully bottle fed. she doubled her birthweight (6.8lbs) by 3 mos.

and i knew all of these things going in; she was my second nicu preemie. my son was a 30 wkr who never breastfed (i ep'ed for 6 mos) and i was determined to make it work this time. but as a pp said, i was told i could take her home quickly if we agreed to all bottles and so we did. breastfeeding in the nicu is a horrible experience and i can imagime why man mother's go home bottle/formula feeding from that place!

[CallMeMommy]

Originally Posted by boobs4milk

there re so many factors that go into breastfeeding in the nicu. here is a run-down of what we went through.

1. change baby's diaper

2. take baby's vital signs

3. get a chair and screen

4. unwrap baby and remove or reposition cords

5. remove all baby's clothes for pre-weigh

6. rewrap baby because if her temp drops below 97.7 she gets tube fed

7. latch baby while being 'assessed' for proper handling

8. be reminded every few minutes that you only have 10 mins for baby to get the minimum (2 oz in our case!!!) or baby gets the tube

9. unwrap baby for post-weigh

so, yea no wonder it wears them out to try to bf. there's too many rules!!! i got her to take 22 cc's once while in there and i got told how 'little' that was and it was not a good bf and i probably would not be able to bf her!!!! i was also told that my breastmilk wasn't adequate calories and i would be starving her if i didn't supplement. they were force feeding her 2 oz every 3 hrs because that's the amount she required to have a 1-2 ounce weight gain per day.

we've struggled with latch but we're at 4 mos old and she's been fully BREAST fed since she was 4 weeks. she came home at 17 days old, fully bottle fed. she doubled her birthweight (6.8lbs) by 3 mos.

and i knew all of these things going in; she was my second nicu preemie. my son was a 30 wkr who never breastfed (i ep'ed for 6 mos) and i was determined to make it work this time. but as a pp said, i was told i could take her home quickly if we agreed to all bottles and so we did. breastfeeding in the nicu is a horrible experience and i can imagime why man mother's go home bottle/formula feeding from that place!

They really pushed breastfeeding at the hospital we were at but oh the rigamarole! Baby has to be fed every 3 hours; that's it. If they're rooting before that, they get a paci. So by the time the magic 3 hours comes around and they want you to try feeding, he's either not interested or asleep. It was so frustrating, I finally had to lie to them about how much he was eating (they didn't do pre/post weights) just to get him out of there because I knew once he could eat on his own schedule he'd do fine. And lo and behold, he did! And that's even with one of the more seasoned nurses bending the rules for us and letting us use the old feeding eval, the "new" one was even more constricting!

[amydiane]

This is very interesting info. Our NICU basically paid lip service to BFing, but in practice, the rules and scheduling made it extremely difficult. In our case, DS would desat often during bottle feeding, but almost never during BFing. He wasn't much for their schedule at all, though, and it was so stressful trying to get him to nurse "enough" in the 15 minutes we were "allowed."

[Juvysen]

Originally Posted by amydiane

He wasn't much for their schedule at all, though, and it was so stressful trying to get him to nurse "enough" in the 15 minutes we were "allowed."

What the heck? (sorry, I came in from new posts)

In the hospital having my fully term + newborn, they harassed me if I didn't nurse *at least* 20 minutes on each side, *at least* every 2 hours... even though DD was clearly peeing a *lot* and all that. Wouldn't it make sense that a *smaller, weaker* baby would need *more* time to do it?

Besides, I thought the whole kangaroo care thing - having baby on your body and all that- made preemies do better?

But then, I have never lived the NICU life (so far), so maybe I'm just missing something :

[CallMeMommy]

Originally Posted by Juvysen

What the heck? (sorry, I came in from new posts)

In the hospital having my fully term + newborn, they harassed me if I didn't nurse *at least* 20 minutes on each side, *at least* every 2 hours... even though DD was clearly peeing a *lot* and all that. Wouldn't it make sense that a *smaller, weaker* baby would need *more* time to do it?

Besides, I thought the whole kangaroo care thing - having baby on your body and all that- made preemies do better?

But then, I have never lived the NICU life (so far), so maybe I'm just missing something :

Because they *have* to get their calories, and if they're spending more than X amount of time (I think we got 20 at our hospital) trying to get those calories, they're more than likely using more energy than they're taking in. In that case, they'd get a tube feeding (or bottle feeding, whatever the hospital policy is).

[amydiane]

Originally Posted by Juvysen

What the heck? (sorry, I came in from new posts)

In the hospital having my fully term + newborn, they harassed me if I didn't nurse *at least* 20 minutes on each side, *at least* every 2 hours... even though DD was clearly peeing a *lot* and all that. Wouldn't it make sense that a *smaller, weaker* baby would need *more* time to do it?

Besides, I thought the whole kangaroo care thing - having baby on your body and all that- made preemies do better?

But then, I have never lived the NICU life (so far), so maybe I'm just missing something :

Originally Posted by CallMeMommy

Because they *have* to get their calories, and if they're spending more than X amount of time (I think we got 20 at our hospital) trying to get those calories, they're more than likely using more energy than they're taking in. In that case, they'd get a tube feeding (or bottle feeding, whatever the hospital policy is).

Yup, though I agree that expecting a ~4lb preemie to take 3 ounces or so from the breast in 15 minutes is unrealistic at best. And that's why this study is so interesting, because it shows that preemies may not need to be so limited in BFing time.

In our NICU, another challenge to the amount of time spent BFing is that they were very big on their schedule, so if a baby took "too long" to eat, they may get off schedule. DS did 1000 times better when he was able to nurse on demand, but doctors like things to be easy to quantify and record.

[felix23]

Originally Posted by boobs4milk

there re so many factors that go into breastfeeding in the nicu. here is a run-down of what we went through.

1. change baby's diaper

2. take baby's vital signs

3. get a chair and screen

4. unwrap baby and remove or reposition cords

5. remove all baby's clothes for pre-weigh

6. rewrap baby because if her temp drops below 97.7 she gets tube fed

7. latch baby while being 'assessed' for proper handling

8. be reminded every few minutes that you only have 10 mins for baby to get the minimum (2 oz in our case!!!) or baby gets the tube

9. unwrap baby for post-weigh

so, yea no wonder it wears them out to try to bf. there's too many rules!!! i got her to take 22 cc's once while in there and i got told how 'little' that was and it was not a good bf and i probably would not be able to bf her!!!! i was also told that my breastmilk wasn't adequate calories and i would be starving her if i didn't supplement. they were force feeding her 2 oz every 3 hrs because that's the amount she required to have a 1-2 ounce weight gain per day.

we've struggled with latch but we're at 4 mos old and she's been fully BREAST fed since she was 4 weeks. she came home at 17 days old, fully bottle fed. she doubled her birthweight (6.8lbs) by 3 mos.

and i knew all of these things going in; she was my second nicu preemie. my son was a 30 wkr who never breastfed (i ep'ed for 6 mos) and i was determined to make it work this time. but as a pp said, i was told i could take her home quickly if we agreed to all bottles and so we did. breastfeeding in the nicu is a horrible experience and i can imagime why man mother's go home bottle/formula feeding from that place!

Wow, we didn't have any sort of schedule like that! I could get her in and out pretty much whenever I wanted by the time she was old enough to attempt nursing, so it was pretty much just getting her out unwrapping her and trying to get her to latch correctly and nurse. I was never told a set time or how long I could try, but it still exhausted her. But for us, she burned more calories trying to nurse then she did drinking out of a bottle.

[boobs4milk]

Originally Posted by felix23

Wow, we didn't have any sort of schedule like that! I could get her in and out pretty much whenever I wanted by the time she was old enough to attempt nursing, so it was pretty much just getting her out unwrapping her and trying to get her to latch correctly and nurse. I was never told a set time or how long I could try, but it still exhausted her. But for us, she burned more calories trying to nurse then she did drinking out of a bottle.

we had transfer issues because she learned to suck on a pacifier and a bottle. i asked that no artificial nipples be given, but i came in one day and the were bottle feeding her. they started when i left and bottle fed her for the night! i was furious, but when i complained, i was told how wrong i was and that nipple confusion didn't exist.

what i don't get is how they can justify the non-nutritive sucking on the pacifier, but not allow me to put her onto the breast while they gavage fed her.

additionally, i don't eat the exact same quantity at every meal and my meals aren't spaced evenly, either. sometimes, i'm hungry again after only 20 min and sometimes i can go 5 or 6 hrs and still not feel like eating. babies can not eat on a scedule! and imposing a rigorous schedule and an amount on the baby based on weight vs. charted need (based on other babies consumption) is ludicrous! i had one dr tell me that feeding on demand never works and that we needed to figure out why a 2 wk old was 'only' eating 2 oz every 3 hrs.

[boobs4milk]

wanted to add that she burned up more calories in a 24 hour period when i demanded to be allowed to bf on demand. she lost .4 oz when she had been gaining 1-2 oz/day. but how much energy can one burn when you are getting milk pumped down your nose?

and unless i was holding her, she was gavaged with a pump while she was laying flat. one of the requirements for going home was that she could lay flat after feeds and not barf!

[Heba]

Originally Posted by CallMeMommy

Baby has to be fed every 3 hours; that's it. If they're rooting before that, they get a paci. So by the time the magic 3 hours comes around and they want you to try feeding, he's either not interested or asleep.

Do you (or any other poster) know the rationale for this scheduling? Just trying to get my head around it.

[felix23]

Originally Posted by Heba

Do you (or any other poster) know the rationale for this scheduling? Just trying to get my head around it.

I think it is most likely for the convienience of the NICU, because the NICU my dd was in didn't have that rule. While being tube fed she was on a schedule, but even then if she started acting hungry they would feed her ealier. This was a new, smaller, private room NICU that was set up for the parents to stay all the time with their baby, so it wasn't like the typical open room NICU. I wish all NICU's were like that, but it is more expensive and most hospitals don't want to change to being more parent centered.