chantal

Re-addressing the varied growth curves used, as a clinical researcher the protocol of 15g/kg/day instituted by a service compels caregivers to adapt new dietary intakes when a baby falls below the "curve". My concern is that it may not be appropriate for certain patients if such gain does not take into account their racial/ background.

This is a question that has been on my mind for a long time! I am not a neonatologist, but a clinical researcher who has worked for the last 3 decades in NICUs with preemie populations in the US. My focus was on their ability to transition readily, or not, from tube to independent oral feeding. As proper “growth” of the infant was an important clinical outcome, particularly when gauged as a weight gain of 15g/kg body weight/day, I have come to realize that some of these infants do not necessarily meet the above criterion despite proper nutritive sucking skills. Due to the broad spectrum of racial/ethnic backgrounds that make up the “melting pot” of the US population, i.e., White/African-American/Hispanic/Asian-Pacific Islander/recent immigrants, I began to speculate whether parental genetics and dietary characteristics may impact on the offspring growth/development. Along this line, as a non-clinician, my concern is whether supplementing a baby’s diet to meet the 15g/kg body weight/day is a proper approach across the board. I was told that in the 1950’s, as growth charts were based on White American babies, Asian babies regularly fell below the “normal” growth curve and were clinically of concern. As such, I personally use the WHO data to monitor my subjects.

Lau '21_NeoToday.pdf I would like to share an article that I wrote for the November issue of Neonatology Today. This peer-reviewed monthly newsletter caters not only to pediatric practitioners, but also parents. This study offers a new outlook on how we may better assist mothers during their infant(s)' NICU hospitalization if we understand the multitude of stressors that simultaneously besiege them at such inopportune time.

It is a very wise decision! I hope we will meet in 2021.

Pre- and post-weigh for breastfeeding need to be done in a very "exact" manner. Also you need a scale that gives you an average weight after a certain period of time, e.g., 10sec, computed from the number of readings taken during that time, as the baby likely will be moving. We have been using the Medela test weigh scale. The important detail is to weigh the infant pre- and post with the same clothing, diaper, etc... Do not change diaper if dirty. Do not add or remove anything baby had on at the start. It is used by the NICU milk bank at our hospital, Texas Children's Hospital/Baylor College of Medicine in Houston TX for many years. It is convenient for mothers breastfeeding in the NCU as they know how much baby has taken. The test-weight is used as intake in their medical chart. Some mothers who are worried about intake at home, will rent such a scale. I believe they can get it from our milk bank. With 1gm = 1ml it is very convenient. I have attached the article from Paula Meier 1996 which "validates" the technique. in Paula's article, she described a different scale. Hope this helps. Meier et al'96 TestWeigh.pdf

If fluid intake is of concern, could one test-weigh the infant pre- and post- breastfeed? This would not be realistic during the 1st few days of life

If fluid intake is of concern, could one test-weigh the infant pre- and post- breastfeed? This would not be realistic during the 1st few days of life

The clinical issues raised by late preterms may be better addressed as suggested by Jain & Raju (editorial attached): "The focus on the late preterm infant seems to have uncovered two other understudied gestational age groups, one on each side of the late preterm spectrum: studies related to “moderate preterm” and “early term” births,4 further highlighted our lack of understanding of consequences of early birth, even if it is by 2 to 3 weeks and the importance of maintaining the gestational maturational continuum." Jain&Raju'13 editorial (LPT).pdf

In collaboration with my long-time colleague, Dr. Richard J Schanler we monitored the oral feeding performance of Late Preterm Infants (LPT) at his hospital using the Oral Feeding Skill (OFS) scale we developed a few years ago (1). The OFS scale helps differentiate between infant oral feeding skills and endurance (2). As mentioned above, depending upon individual hospital policies, LPT may be transferred to different levels of care. However, due to their relatively short hospital stay, it remains at times difficult to identify those that may be at risk for oral feeding issues. In our study, we observed that assessing the OFS maturity levels of LPTs at their first oral feeding can help identify these at-risk infants early on. We speculated that provision of evidence-based efficacious interventions that improve OFS may shorten hospital stay and decrease future re-admission. (1). Lau C, Bhat J, Potak D, Schanler RJ. Oral Feeding Skills of Late Preterm Infants are correlated with Hospital Length of Stay. J Ped Moth Care 2015; 1:102; (2). Lau C, Smith EO. A novel approach to assess oral feeding kills of preterm infants Neonatology 2011;100:64-70 (doi: 10.1159/000321987) Lau et al'15 (LPT).pdf Lau & Smith '11.pdf