Introduction & question about feeding preemies

Hello! I'm new to this forum (though I recognize some of you from the Expecting forum). My identical girls Allison and Cecilia are 7 weeks old. They were born at 31 weeks, so we got Allison home a little over a week ago and Cecilia home on Monday. Their original due date was June 28th so their adjusted age is -2 weeks! In any case I think we're doing okay taking care of them so far -- we got a lot of practice under supervision in the NICU and then we got a week with just Allison to adjust.

I have a few questions for the other parents of preemies. Our girls are on 4-5 breastfeedings + 4 bottles of fortified breastmilk per day (depending if they eat 8 or 9 times). I'm trying to figure out whether it's better to do all the breastfeedings overnight and the bottles during the day, or a mixture. Anyone do this and have advice? Eventually I will be going back to work so even when we are allowed to stop fortifying the milk they'll still need to take bottles during the day. On the other hand it would be nice to let DH handle a night feed. On the other other hand, if I don't breastfeed at night I have to get up to pump anyway.

Second question -- our babies are grunters. They are so gassy, and they grunt and groan all the time about their gas problem (I know that's the problem because they'll grunt a lot, then toot, then relax). We give them gas drops to help, and the NICU nurses said it's probably from the fortifier in their bottles. Did anyone else have grunty, gassy preemies? When did it go away?

Last question! They spit up all the time too. They say this may also be a preemie thing, but term babies do it too. We prop them up for 15+ mins after feeds, but they still end up spitting up (sometimes as soon as they stop eating, sometimes later). Does the propping really help at all? It makes our night feedings take forever. They sleep better propped up than they do in their crib so during the day it's fine when we're awake and watching them, but at night I just want to go back to sleep and I can't while they're propped up.

Anyway, just looking for some advice and/or commiseration! We try to play with them when they're awake, but sadly they like to do it in the middle of the night. Oh well!

 

Congrats on your twins!

Mine were born at 36 weeks, so not so small, but everything you are describing sounds common with earlier more premature babies.

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I would also post for some advice in breastfeeding, but my recollection is mine ate more via the bottle, so that might be better (and faster) at night? It's really all trial and error. And just when you think you can't take it anymore - they outgrow whatever issue

 

We did the breastfeed + fortified BM bottles as well (Similac Neosure). I did all my nursing sessions during the day. Nursing did not come easily for us and it was even more difficult doing it half asleep. I nursed most feedings during the day then followed with a bottle. We did only bottles at night (and I pumped 2 times). To be honest, this routine was exhausting even during the day and I gave up breastfeeding and switched to just pumping after they were home for about 5 weeks. I always wished I had stuck it out but it was the right decision for me at the time.

My twins were DEFINITELY grunters, but so was my singleton son and he was strictly breastfed... no formula. My twins rarely spit up and my singleton son spit up ALL THE TIME until 10 months. So, it could be the formula or they could just be spitters. Either way, you are doing everything you can with the gas drops and propping them up. If they spit up so much it is affecting their weight, the doctor may give you medicine. Mine didn't need it, though.

We slept our twins swaddled in their papasan bouncy chairs until 3 months. It kept them slightly propped, but not so much they could slump over. It helped with the grunting. I slept on the couch next to them (they didn't sleep with us in our room because their noises kept my husband up).

Congrats on your baby girls!!!

 

Post in breastfeeding. That was my lifeline when my girls were babies,

 

Thanks guys! I feel like I have a million questions. Right now we wake them up to eat if it's been 3 hours since the start of the last feeding. Sometimes they're sleepy and don't eat well, then wake up early the next time around. The NICU nurses told us to do this until two weeks after their due date, but most of the time they're so good at telling us they're hungry I wonder if we should switch to demand feeding now. I mean, if they are up early we will feed them rather than waiting, but I feel like sometimes they just want to sleep for four hours instead. How long did you go before you stopped waking them up to eat? I feel silly jostling them around to wake them up enough to eat a little when the rest of the day they root around like crazy and fuss if they're hungry.

Also, I'm wondering about swaddling. In the NICU, they wore onesies and were swaddled in a blanket any time they weren't being held, with room temp 70-73. At home we're doing the same. It seems like they spend a LOT of time swaddled this way (in a sleep sack). Is that okay? They still don't really do anything other than eat and sleep, plus a little tummy time.

 

Have they increased the amount they are drinking? In order to go longer periods they have to be able to take more in at each feeding so that their total for the day doesn't decrease? How is their weight?
It seems early to me but every baby is different.

Swaddling is very important for preemies. They are suppose to still be in the womb where everything is tight around them. they need this close space to build muscles by pushing against it. Swaddles should be snug and include arms and legs for this reason. In addition, it provides a security. My LOs preferred sleeping in their swaddles for a long time.
ETA: they can not spend too much time in their swaddles.

Interesting note, (that may or may not apply to your babies):
When swaddling make sure legs are bent and close to body. Most babies naturally do this but my DS would straighten his legs. Which meant he didn't get the benefit of pushing against the sack. A nurse showed me how to wrap him.. folding his legs and pulling the bottom part of the wrap snug.

They are doing what they are suppose to.. eating, sleeping, growing. I remember thinking 'all they do is sleep! When are they going to get social?' That is one of the hard parts about preemies. They are here but not really.
It feels like forever, but soon they will 'wake up' and you will think.. 'hey, there you are. We've been waiting for you!'

 

You should expect them to remain fairly sleepy until they reach their EDD. Then you'll likely find they gradually have more awake time.

The concern with swaddling is if you swaddle their legs tightly while their legs are straight, it can effect their hip socket development. However if you swaddle their legs fairly loosely or in a "frog position" plus allow them swaddle free time whenever they're awake, they'll be fine.

As for the grunting that is par for the course with prem babes. They are noisy! Term babes can be too but it's extra normal for prems.

In terms of stretching out feeds, if they're gaining well, I would definitely talk to their doc about it at their next appointment. Bring up your concerns, see what they say and go from there.

 

They've been gaining well so far, and are starting to catch up to their growth curve (they were <10% before). We haven't increased their feeds this week since sometimes they still don't take their whole bottle, or they eat really slowly with a lot of starting and stopping. I'll ask the pediatrician about it at our appointment Friday though.

 

Are you tapping their bottle when bottle feeding to remind them to eat. We had to do this with Jessa as she was so tiny. She would start to get sleepy before she was done. We did feeds every 2 hours until they were 8 weeks and I went back to work. We were struggling to wale them. Then we really only had 1-2 night feeds. I quit pumping then as I had supply issues as it was before going back to work and after it wasn't feasible to pump at work for the little I was getting. I'm quite large breasted and I think the pump was too small. Mine never could nurse because of mouth to nipple ratio. My girls came home separate too. My Jessa is still petite compared to Jazzy.