Food for Thought: To HMF or not to HMF

After battling CONS in the first few weeks of his hospital stay, my son dropped quite a bit of weight and the doctors were anxious to see his weight trending in the other direction.  Without much discussion, the put him on Human Milk Fortifier (HMF); one pack at first, increasing to two packs within 48 hours.  I attended rounds the day they decided to put him on HMF and no risks or potential side effects of the move were ever discussed.  


Within two days my son had blood in his stool and an xray revealed a lot of air in his intestines.  The doctor sat me down and explained that they were not certain, but had concerns that he was suffering from a very serious disorder called NEC.  One in three babies who are diagnosed with NEC die, so this potential diagnosis was very serious.  They immediately discontinued oral feeds and placed him on fluids to give his gut a rest.  My son did not eat for two days before the next xray revealed that it was not NEC.  They put him on an elemental formula Neocate which he tolerated.  Since it wasn't NEC, they believed that my son had developed a cow's milk protein allergy, possibly because of the early introduction by HMF.  I ended up on a dairy-free diet (which is harder than it sounds) because the protein transfers through breastmilk.  He remained on Neocate for almost 10 days at which time they slowly re-introduced breast milk.  As you can imagine, two weeks of little/reduced feeding really impacted his growth rate and his weight dropped from the 50th percentile to below the 3rd percentile (even on an adjusted chart).  


We were unable to find studies that clearly link HMF to NEC or NEC scares but heard countless stories from other doctors, nurses and moms where there seemed to be an undeniable correlation.  Doctors and parents are in such a hurry to fatten up the baby and supplementing breastmilk seems like the easiest step to accomplish that goal.  And while this goal is understandable, parents need to ensure they understand and consider whether HMF is right for their little ones.  The problem is the young gut often cannot handle cow's milk and even if NEC does not develop, the possible setbacks from a NEC scare should be considered before such steps are taken. 


I wish I had realized at the time the risk associated with introducing cow's milk at such a young age; had I known I would have insisted they push up feeds rather than use HMF.  I would never have let them use HMF on Elie.  If you find yourself in the same boat, speak to the neonatologist and see what other options you have or if you can you try to merely increase volume rather than supplement with HMF.  Breastmilk is easiest to digest and safer for your baby.


The links below provide some additional information for your consideration.  If you find yourself in the same situation, please leave a comment so that others can hear your story. 


http://www.ncbi.nlm.nih.gov/pubmed/17100376
http://pediatrics.aappublications.org/content/114/6/e699



Thanks

Hospital Grade Breast Pump

If you were like me, and had no warning of an early delivery, the last thing you had probably had a chance to get was a breast pump.  I hadn't even really given the whole feeding exercise much thought, and assumed things would just come easy.  Good quality breast pumps are crucial for moms of preemies so that we can build up our milk supply while the baby is maybe too young to breastfeed or still in the NICU.  Nurses warned us that even the most eager breastfeeders went home being bottled at least half time so we realized right away the importance of getting a good quality breast pump.  

The hospitals provide a print out of all the pharmacies in town that rent breast pumps.  We went through a dozen before renting the Medela Symphony (same as the hospital) from the Shoppers off of Macleod Trail.  They only have a few pumps so call ahead.  When my pump's motor gave out and they had no other pumps to rent, we found One Tiny Suitcase.  They rent Medela hospital grade breast pumps with free delivery. The cost was the same as with Shoppers and they had all the accessories (bottles, shields, etc).  Definitely worth the cost of a good quality pump.

http://www.onetinysuitcase.ca/

Too Early, Too Small

Too Early, Too Small: H118-56/2009E-PDF

A Profile of Small Babies Across Canada

Babies who are born preterm (before 37 weeks of gestation) or small for their gestational age (SGA) are at increased risk of mortality and morbidity. This report examines the relationship between selected factors and preterm and SGA births for all provinces and territories (excluding Quebec) using 2006-2007 data from CIHI's Discharge Abstract Database. Information on the hospital costs of preterm, SGA and low birth weight newborns is also included.

http://secure.cihi.ca/cihiweb/products/too_early_too_small_en.pdf

75% off Train Travel

Via just posted a sale of up to 75% off travel on the Canadian (Vancouver-Toronto).  RSV season is on until April so consider making the trip by train.

http://www.viarail.ca/en

Helpful Books

I stumbled across an older edition of Preemies in the waiting lounge at FMC and immediately went home and sourced it out, along with as many other books on preemies as I could find.  Here's a list of the books I found most helpful:

1. Preemies, Second Edition by Linden, Paroli and Doron (2010)
2. The Premature Baby Book by Sears (2004) 
3. The Preemie Primer by Gunter (2010) 
4. Your Premature Baby, the first five years by Bradford (2003)

Baby fat? Doctors urged to weigh newborns' ethnicity when judging health

Baby fat? Doctors urged to weigh newborns' ethnicity when judging health

New Birthweight Curves (Gestational Age 23-41 wks)

Birthweight curves for newborns according to maternal ancestry

Canadian data suggests that infants born to parents of East Asian and South Asian ancestry may be of lower birth weight than those of White European decent. Using traditional newborn birthweight curves, some Canadian newborns of East Asian and South Asian ancestry may be misclassified as small for gestational age birthweight (SGA), while they are actually normal in birthweight if compared to other East Asian and South Asian infants.

http://www.stmichaelshospital.com/birthweights.php

Winter travel

In my last post, I mentioned traveling across the country with my little one.  Traveling in the winter is not as easy as it would be any other time of the year.  We thought that there may be an issue with air travel because of the change of pressure but learned from our doctor the real issue: colds, germs and RSV are next to impossible to avoid during air travel over the winter months.  We've all been there; trapped on a plane next to someone who keeps hacking or sneezing.  I rarely get sick but it almost always happens after a flight.  It's not a stretch to think that a preemie would stand no chance of avoiding a cold or worse in those circumstances. 

So we considered the alternatives: it's completely impractical to drive from Alberta to Ontario and not safe to keep your child in the car seat for any extended period of time.

And that's how we found ourselves traveling by train from Alberta to Ontario.  We got ourselves a 2 person cabin, which included a private bathroom. This allowed us to keep him in the cabin at all times, away from all the germs.  We cavi-wiped the cabin when we first arrived and he had no idea he was confined to such a small space for the duration of the trip. Rather than take turns eating in the dining car, we had room service for all our meals.  There are obvious downsides to train travel: departure is from Edmonton so added driving time, overall travel time, cost and comfort.  The upsides were that we had our own space and the food was good (always had vegetarian options available and they made my food dairy-free upon request).  The most important upside was that it gave us peace of mind that we were limiting his exposure on a much needed visit with family.

Via has 50% sales in down periods so if you keep your eyes open you may be able to get a good deal. Consider train travel www.viarail.ca/en/deals.     

RSV Season - no need to test my son's immune system just yet

We just returned from a trip across Canada with my son. Traveling with a preemie, especially during RSV season is stressful and can be risky. Preemies are at an increased risk for complications from a serious, pediatric illness called Respiratory Syncytial Virus or RSV. 

RSV is a virus that causes a respiratory tract infection. RSV is the most common cause of bronchiolitis and pneumonia and is the leading cause of viral death in children under the age of five. RSV is the number one reason for hospitalization of children under the age of one.

Preemies are at a high risk for catching RSV for a number of reasons, however it is largely because normal lung development is cut short.  Preemies have neither developed a normal immune response yet nor the lung capacity of full-term children. This makes it difficult for these infants to fight infections, and is why RSV can turn very serious very quickly. Serious cases of RSV can lead to hospitalization and, sadly, death for some infants. If you have spent any time in an NICU, you have surely heard the warnings from the doctors and nurses about the serious risk.  


There are several factors that increase the risk of serious RSV infection and hospitalization, including:

•                Preterm birth

•                Chronic lung disease

•                Congenital heart disease

•                Immunodeficiency

•                Exposure to second-hand smoke

•                Daycare attendance

•                Multiple birth

•                Family history of asthma

•                Birth within 6 months of the onset of RSV season

In Calgary this year, RSV season began in late November and is expected to last until April. It is very important to take precautions during this period.

Although RSV symptoms are similar to a cold and include: fever, runny nose, and coughing, more serious symptoms include wheezing, difficulty breathing, inability to eat, and apnea. The symptoms can develop quickly and preemies can get very sick in a short period.  

RSV is passed by sneezing, coughing, or by hands touching the nose or eyes and then coming into contact with another person or object. RSV can survive up to 6 hours on hands and up to 12 hours on surfaces.  Our physician strongly encouraged that we limit our son's exposure to public places where they can come into contact with people who might be sick, such as at malls, day cares, grocery stores, large family gatherings, especially when other children who might be sick are present. 

GOOD HANDWASHING IS VERY IMPORTANT TO MINIMIZE RISK

•                Require everyone who comes in contact with your child to wash their hands 

•                Keep your baby away from crowded places during RSV season

•                Limit exposure to people who are sick even if they are getting over a cold – don’t be afraid to tell friends and family that they can’t visit if they are sick

•                Keep your baby away from people who smoke

            One of the hardest things for parents of preemies is to explain to other parents why you are treating your baby differently.  People will make comments about how it is good to help your child develop immunities by exposing them to sick people.  In the case of a preemie, it simply isn't true. DO NOT BE AFRAID TO TELL FRIENDS AND FAMILY THAT THEY CAN'T VISIT IF THEY ARE SICK.  People will understand and waiting a few weeks, or even a few months to visit is not a long time in the lifetime of your child.  Your friends and family will understand.

If you would like additional information, please check out the following links:

http://www.lung.ca/diseases-maladies/a-z/rsv-vrs/index_e.php

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/pneumovirus-eng.php

http://preemies.about.com/od/preemiehealthproblems/a/RSVinPreemies.htm
https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=hw176517&

http://www.albertahealthservices.ca/rsvprogram.asp

Consider Probiotics

Premature babies are more likely to suffer from gas pains, transient lactase deficiency and colic because of their immature digestive systems.  Bio Gaia Probiotic Drops were referred to us as a preventative measure to reduce gas. The drops contain lactobacillus, a form of good bacteria that naturally occurs in our stomachs and aids digestion. You simply give your baby 5 drops a day, either in a bottle mixed with milk, or directly into their mouths. 

The product must remain refrigerated, and is not carried by all pharmacies so it is a good idea to call ahead. Ask your doctors whether they think it may help if you're having difficulties with your little one.

http://www.biogaia.com/consumer/facts-about-infant-colic