Case Study: Successfully Breastfeeding the Premature Infant Melissa Nash, MPH, RD Washington County Field Team
NICU info n Bryan is an ex-31 wk premie n No major complications in NICU n Discharged at 36 wks CA n Mom had great milk supply in the NICU: n Pumped 6 oz q 3 hrs n Discharge meds/vits: ¨ No meds & 0. 5 MVI w/ iron n Discharge feeding plan: ¨ EMM + Enfa. Care to 22 kcal/oz
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
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 postdischarge)
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
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
Growth Grid
1 month CA (WIC appt) Weight check: ¨ Avg 1 oz/d x 3 wks Feeding history: ¨ EBF at night (no pumping/bottle) ¨ EBF 2 -3 x/day ¨ Offers breast + fort bottle 2 -3 x/day Nutrition Plan: ¨ Start EBF ¨ Continue w/ 1 ml MVI w/ iron
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
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 Enfa. Care (mom to pump & freeze milk) 2. BF + fortified bottle + pumping q feeding 3. Continue to EBF + start Tribasic
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/ ~5 ml breastmilk ¨ Give via syringe or infant spoon
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
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
Скачать презентацию Case Study Successfully Breastfeeding the Premature Infant Melissa
a6271984fc9d6d7253ac161ac7510335.ppt