preemie weight gain question

[freegirl23cat]

Hi all!  Does anyone know if there are different expectations for weight gain for preemies vs. FT babies?

My dd was born @ 32 weeks b/c of preeclampsia.  She was sent home from NICU 10 days ago at 6 lb 10 oz.  She had almost all EBM in the NICU having rarely successfully transferred directly from breast.  Our first 2 days home I put her to breast on demand and supplemented 2x w/ 1 oz bottles of BM + neosure 24 cal.   At her first ped visit she had gained 2 oz or 1 oz/day.  Ped said excellent!   I did not give her any more supplements of neosure b/c we've been working on exclusive breastfeeding this last week.  We just went again today for a weight check she had only gained 3.5 oz. in one week.  Ped says she is concerned and wants me to give her some formula.  I am just remembered how NICU staff always talked about how it is harder for infants to breastfeed and how it burns calories and wondering if this may be why she hasn't gained as much?  She has the appropriate number for wet diapers and several normal stools a day.  She rarely spits up and when she does it it is more of a dribble.  She shows no signs of hunger.   Ped is new and young and don't know how much experience she has with preemies? 

How concerned should I be with 3 oz weight gain in one week?  What has been your experience with weight gain?  EBF'ing?  supplementing? 

[Ratchet]

IMO- it is more importan to know the big picture rather than just 1 week.  Overall, the goal is 1/2 to 1 oz/ day, so she's a little behind, but If you want to try another week of exclusively breastfeeding I bet it wouldn't hurt.  Maybe this was just a 'transitional' week and once she gets the hang of things more she'll gain more.  And if she is still not gaining as much, you could reconsider.

[MadelinesMama]

I personally was a bit annoyed at how much pressure they placed on us for weight gain.  Yes, I understand he needs to grow, but I had a baby who would gain 1 oz a day for a week and then maybe have a few days of only gaining 1/2 oz.  IMO, that isn't a reason to supplement.  I would give it a few weeks and see how you feel about things.  Trust your instincts. 
 

[preemieprincess]

It depends on how severe the lack of weight gain is. DD's experience is a bit different, as I'm dealing with an underweight toddler, not a newborn. However, I thought my experience might be helpful to you.

DD, (born at 34 weeks, 3.5weeks in NICU, less than 5lbs at 1mo) gained weight beautifully for her first few months. Aside from a few bottles of formula in the hospital (given to her against my wishes, BTW) she was otherwise EBF for her first 8 months. There was a LOT of pumping in her first 3 months.

She continued to nurse about 8-10x a day as we began to introduce solid foods beginning around 8 months. Due to her developmental delay, she's unable to chew and swallow as well as most kids at her adjusted age, which in turn has affected her ability to maintain a healthy weight. Her weight would go from the low end of healthy to significantly underweight, and her Doc was concerned with all the peaks and valleys in her growth chart. Doc is 100% in support of extended BF, and follows the WHO growth chart for BF babies. Doc also realizes that babies come in different shapes and sizes, and that a very small baby is not necessarily unhealthy just because s/he's very small.

At about 1YO, at Dr's urging, we began to supplement with Pediasure. I felt guilty at first, until I saw her begin to gain weight, muscle mass, and strength to kick some butt on her PT exercises! She really began thriving once she packed on the pounds. She's 21mo now, and still loves nursing. We are slowly cutting out the Pediasure, and replacing it with other high-calorie beverages (yogurt smoothies, chocolate milk, etc) as her weight gain is still a concern, but no longer as dire. She's still struggling with chewing, and the supplemental formula made a tremendously positive influence in DD's overall health.

I'm from the camp of "Breast is not best. Breast is the biological norm. Anything else is an inferior substitute." However, I firmly, whole-heartedly, 100% believe that formula is a wonderful thing when it is needed. If it is possible, you should try to get the opinion of another doctor. You can always find a La Leche League mama through their website who'd love to help you (llli.org). Formula is not be the best thing for most babies, but it can be the best thing for some babies.

[maryeliz]

There are different growth chats for preemies/low birth rate babies.  My dd (29w) has consistently been in the 75% on the preemie chart and the 5% on the regular chart.  The ped has always said that as long as she is following a decent curve, he doesn't worry.  I would definitely give it more time before adding the formula, particularly if she seems otherwise healthy, happy, and satisfied.

[My dd maintained her curve whether on breastmilk, formula, or table food.  Some kids are just smaller and slower gainers.]
 

[freegirl23cat]

thnx mamas! I asked to see another dr. @ practice and she was better. I
am giving a 24 cal bottle 1-2 times a day now. At our follow up appnt. Weighed @
5 oz ib 4 days...this doc echoes as long as she stays on a curve.

[~bookcase~]

edit

Edited by ~bookcase~ - 7/30/12 at 1:48am

[preemieprincess]

I thought I'd clarify that my daughter was sometimes *losing* weight when she grew a few inches, and was not following a steady curve on *any* growth chart.
 

[onetrumpeter]

freegirl, just wondering how you all are doing?  are you still offering 1 or 2 24 cal/oz bottles a day?  how is your little one's growth?  so tough to be concerned about their growth when they're so tiny and don't have much to lose, anyway!!