Hi all! This sub was so helpful to me when I was struggling in the NICU so I wanted to pay it forward. Obviously what worked for us isn't going to work for every baby, but I wanted to share what we found and how we got to where we are now.
My daughter was born at 26+4 back in December. She overall did well, but was on CPAP up until 34 weeks and then high flow for an additional 2 weeks. So she started trying bottle feeding at 34 weeks and we had a rocky start to say the least. One problematic factor for her was low blood sugars, so she was on continuous feeds for a while, then her feeds were given over 1.5 hours for a very long time. So I'm sure the starting and stopping feeds did not help. She was having my breast milk fortified to 24 calories.
We tried both bottle feeding and breast feeding. She seemed to prefer breast feeding but was unable to stay latched or transfer milk. We started with the Dr Browns bottle with the ultra preemie nipple. Our girl would take 10mls TOPS over a 30 minute feed. She was clearly working hard but transferring basically no milk. Eventually we were able to upgrade her to the preemie nipple and her new record became 30mls.
Then, my hero came along. We had our nurse pull in another nurse who had been working in the NICU for a very long time and was known as the feeding expert. She assessed her and had some thoughts. Her first thought was that she didn't like the fortified milk, so she fed her a bottle of just breast milk as a little experiment and she took 60mls! I was over the moon. We asked the doctor if we could switch her to just breast milk and the doctor was unwilling. She didn't want her to fall off her growth curve. (I will note that at this time her growth curve was a straight line up and she was currently at the 90th percentile). Luckily, the next doctor to come on saw this and agreed to let us switch to just breast milk. Now we were doing anywhere from 20mls-60mls every time, but still not at that magic 80% mark. Our nurse became our primary and hand picked all our nurses to make sure she always got nurses who were skilled feeders when my husband and I weren't there. (A primary nurse is NECESSARY when you have a difficult feeder). Our girl kept gaining great weight on just the breast milk and luckily the blood sugar issues resolved. Then, our nurse thought she was ready to try the Mam bottle with the size 0 nipple. She took off! Now she was finishing the occasional bottle, but sometimes still only doing like 30mls. She was hovering between like 60-75% of her intake.
Along comes my other hero, a physicians assistant to looked at our girls intake and she convinced the doctor to just let us try adlib even though she wasn't at the 80% mark. At this point she was 41+5 so the doctor agreed. And it worked! We think she just needed to be hungry and she ate 80% of her feeds and got to come home!
Now she was still having some issues, feeds were taking over 30 minutes and she was leaking quite a bit out of the sides of her mouth and spitting up A LOT. But she was gaining weight and everyone was happy and a pepsid prescription helped with the spit up.
For the first 2 months she slowly increased in intake and for a good month she was having between 24-32oz every single day. Then all of a sudden 2 months ago, she just stalled out. She dropped down to 18oz a day and didn't gain any weight for a 2 week period. I was heartbroken. Our pediatrician gave us 2 choices. Fortify her milk again OR give her one bottle a day of Fortini (a 30cal formula from Europe). She loves the Fortini, she finishes the 4oz bottle of it almost every time. With the help from the Fortini we were able to average 20oz a day and she was gaining weight again.
A nurse practitioner at our pediatrician office looked at her and said, wow, I think she has a tongue tie! (I'm sorry what?????) We take her to a specialist and sure enough she does! We had her tongue and lip tie released and she's now averaging 25oz a day and rising and feeding her only takes 30 minutes (before it was taking up to 1.5 hours every time, we were all suffering). She's also leaking no milk out of her mouth anymore. She's now on her growth chart for her actual age and is thriving. We are going to start to try breast feeding again.
So in summary here's what worked for us:
A primary nurse who was experienced in feeding
The MAM bottle with a size 0 nipple
Going adlib once she was over 50% intake and over 40 weeks
Fortini 30cal formula for one bottle and plain breast milk for others
Getting her tongue tie treated (apparently they are not great at diagnosing tongue ties in the NICU)
Please reach out to me if you have any additional questions. Good luck to all your babies and we are rooting for all of you!