1 / 13

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:

wilbur
Download Presentation

Case Study: Successfully Breastfeeding the Premature Infant

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study: Successfully Breastfeeding the Premature Infant Melissa Nash, MPH, RD Washington County Field Team

  2. 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

  3. 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

  4. 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 post-discharge)

  5. 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

  6. 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

  7. Growth Grid

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

More Related