Re: 3hr feedings for a premie? - twice as many calories?

[Guest guest]

In the following article (sited here recently?) the authors discuss how late

preemies are more vulnerable to temperature instability, have higher metabolic

rates and do not have the fat and glycogen stores of a full term baby, hence

requiring more calories than a term baby - twice as much is not mentioned.

" Increased Lactation Risk for Late Preterm Infants and Mothers " by a Meier,

Furman and Marguerite Degenhardt published in Journal of Midwifery &

Women's Health, Volume 52, No. 6, November/December 2007

McCormick

(love this list so much!)

********

Years ago, I learned at a conference that SGA babies require twice as many

calories to gain an ounce as normal-for-gestational-age babies.  (I assumed

they meant until the baby gets caught up to normal.)  Anyone here know if that

information is still considered to be true?

Dee Kassing

[Guest guest]

We do give them fortified feeds for more calories and other vitamins and

nutrients, but we certainly do not double the calories. And it's very risky to

increase volume to compensate to that extent it puts them at risk for NEC,

especially the littlest most fragile babies.

I think this is where parents sometimes struggle. They feel like this is an

expression of breastmilk insufficiency, where I try to explain to them that,

particularly with preterm infants, it is not that your milk is less than ideal,

it is simply that the baby has not acquired all of the nutritional stores that

are a component of a term pregnancy. Preterm babies are just not 'smaller'

versions of a term baby, they have unique developmental characteristics that

separate them from term infants, but I know many parents are understandably very

uninformed about this so my first visit, time permitting, I try to describe for

the families the typical progression of feedings for babies born at this

gestational age.

What I sometimes struggle with is when someone provides the parents with some

random piece of research that has been taken out of context concluding they

'can' breastfeed. I have had mothers of 34 weekers come in and explain they have

discontinued pumping, and want the gavage tube removed and refused any feeds

other than at the breast, because they read a study 'so and so' provided them

showing baby's at this GA 'can' breastfeed. Here's where it becomes problematic,

yes they can, and given the opportunity on occasion they will, and we want to

make sure that we are putting the effort to provide them lots of opportunities.

But here is where people who do not work with preterm infants get

confused....they cannot (of course depending on GA) 'sustain' 100% effective

feeds at the breast. Breastfeeding once in a while is not sufficient. So I end

up being the one to put it all into context for them.

>

> In the following article (sited here recently?) the authors discuss how late

preemies are more vulnerable to temperature instability, have higher metabolic

rates and do not have the fat and glycogen stores of a full term baby, hence

requiring more calories than a term baby - twice as much is not mentioned.

>

> " Increased Lactation Risk for Late Preterm Infants and Mothers " by a

Meier, Furman and Marguerite Degenhardt published in Journal of Midwifery

& Women's Health, Volume 52, No. 6, November/December 2007

>

> McCormick

> (love this list so much!)

>

> ********

> Years ago, I learned at a conference that SGA babies require twice as many

calories to gain an ounce as normal-for-gestational-age babies.  (I assumed

they meant until the baby gets caught up to normal.)  Anyone here know if that

information is still considered to be true?

> Dee Kassing

>

[Guest guest]

Sounds like even if not twice as much, these differences between late premies and full-terms would definitely account for significant difference in caloric requirements. Thanks for sharing, !

Dee Kassing

In the following article (sited here recently?) the authors discuss how late preemies are more vulnerable to temperature instability, have higher metabolic rates and do not have the fat and glycogen stores of a full term baby, hence requiring more calories than a term baby - twice as much is not mentioned."Increased Lactation Risk for Late Preterm Infants and Mothers" by a Meier, Furman and Marguerite Degenhardt published in Journal of Midwifery & Women's Health, Volume 52, No. 6, November/December 2007 McCormick(love this list so much!)********Years ago, I learned at a conference that SGA babies require twice as many calories to gain an ounce as normal-for-gestational-age babies. (I assumed they meant until the baby gets caught up to normal.) Anyone here know if that information is still considered to be true?Dee

Kassing

[Guest guest]

And, of course, the information from both and has to do with preterm infants, whereas my comment was for SGA babies, who are not necessarily premature. I don't think the speaker at the conference (and I no longer remember who said it, or I'd try to contact them directly) had premies in mind when the comment was made.

Dee

Subject: Re: 3hr feedings for a premie? - twice as many calories?To: Date: Sunday, May 29, 2011, 10:08 AM

We do give them fortified feeds for more calories and other vitamins and nutrients, but we certainly do not double the calories. And it's very risky to increase volume to compensate to that extent it puts them at risk for NEC, especially the littlest most fragile babies.I think this is where parents sometimes struggle. They feel like this is an expression of breastmilk insufficiency, where I try to explain to them that, particularly with preterm infants, it is not that your milk is less than ideal, it is simply that the baby has not acquired all of the nutritional stores that are a component of a term pregnancy. Preterm babies are just not 'smaller' versions of a term baby, they have unique developmental characteristics that separate them from term infants, but I know many parents are understandably very uninformed about this so my first visit, time permitting, I try to describe for the families the typical progression of feedings for babies

born at this gestational age.What I sometimes struggle with is when someone provides the parents with some random piece of research that has been taken out of context concluding they 'can' breastfeed. I have had mothers of 34 weekers come in and explain they have discontinued pumping, and want the gavage tube removed and refused any feeds other than at the breast, because they read a study 'so and so' provided them showing baby's at this GA 'can' breastfeed. Here's where it becomes problematic, yes they can, and given the opportunity on occasion they will, and we want to make sure that we are putting the effort to provide them lots of opportunities. But here is where people who do not work with preterm infants get confused....they cannot (of course depending on GA) 'sustain' 100% effective feeds at the breast. Breastfeeding once in a while is not sufficient. So I end up being the one to put it all into context for them.

>> In the following article (sited here recently?) the authors discuss how late preemies are more vulnerable to temperature instability, have higher metabolic rates and do not have the fat and glycogen stores of a full term baby, hence requiring more calories than a term baby - twice as much is not mentioned.> > "Increased Lactation Risk for Late Preterm Infants and Mothers" by a Meier, Furman and Marguerite Degenhardt published in Journal of Midwifery & Women's Health, Volume 52, No. 6, November/December 2007> > McCormick> (love this list so much!)> > ********> Years ago, I learned at a conference

that SGA babies require twice as many calories to gain an ounce as normal-for-gestational-age babies. (I assumed they meant until the baby gets caught up to normal.) Anyone here know if that information is still considered to be true?> Dee Kassing>

[Guest guest]

I appreciate your making that distinguishing point because you're right, they

really are very different issues. Sometimes the present together, and sometimes

not. When combined, we are dealing with both, but we can have SGA or IUGR term

infants too.

There are points across a spectrum that SGA infants fall upon. And it really

depends on which point they fall across this spectrum, but I know that doubling

caloric intake is not the approach I have ever seen used, or supported in our

SCN. One area of focus for SGA or IUGR babies is protein intake, so a slightly

higher caloric feed with increased protein, and other nutrients. It isn't safe

to just concentrate calories without consideration for the effect on the ratio

of the other nutritional elements, it can actually cause detrimental side

effects. They've messed with some of the ratios of calories and various

nutritional components and found some combinations promote for example brain

growth, some are better for cardiovascular health, some for bones, and they are

trying to find the combinations that best support all body systems while

minimizing side effects.

I'll keep my eyes peeled for studies discussing the rationale behind approaches

for serving this population and share when I come across them!

H. Kinne BA IBCLC RLC ICCE CD(DONA)

www.CascadePerinatalServices.com

[Guest guest]

Thanks for keeping an eye out for further studies, . I should add here that I'm not sure the speaker was making to point to double the baby's calorie intake. I think that perhaps the point was that these babies may continue to grow a bit more slowly *because* they won't gain an ounce until they have taken in twice as many calories as a AGA (appropriate for gestational age) baby. In other words, because they need twice as many calories to gain an ounce (if indeed they do), they may not put on 1/2-1 ounce/day because they'll need to take in more to get that ounce. So my take on this is that perhaps they can take in *a bit* more than average (many "normal" babies do that anyway!) so that they do gain, but just don't gain as fast as AGA babies. But given time, the extra calories they take in will eventually help them catch

up. I think the key was patience and a watchful eye.

Dee Kassing