NICU - Weaning off the IV fluids

Increasing milk intake & gradually weaning off the IV fluid is one of the major milestones for a preemie.

The first few days, Dora was given 0.5 ml of colostrum (the first milk before breastmilk production begins) on top of the IV transfusion. That was it, just 0.5 ml of colostrum as the colostrum is known the best immune booster.

On the 5th day, team decided to slowly increase the amount of milk (Keeping the IV fluid) and started introducing 2 hourly feedings, each feeding being 0.5 ml. So, in total she would take 6 ml of breastmilk a day.

On day 11, milk came back in a greenish color. As her stomach was not properly developed, she was not able to digest the milk properly. On the 12th day, we went back to IV feeding only with zero breastmilk. BACK TO SQUARE ONE.

This process is one step forward, two step backwards. And sometimes a few steps forward in a row. So hang in there!

Stomach scan came back fine so decision was just to take a break and let the stomach rest for a couple of days. On the 14th day, feedings introduced as 2 ml every 2 hours, and we never looked back:) Each feeding was increased by 1 ml each day to smoothly make a transition to milk feedings only.

Weaning off the IV fluid

There is a calculation for the minimum amount of milk intake for premature infants. Not sure if this is same across all NICUs but idea should be similar. In our NICU, calculation was as below:

Total ideal DAILY milk intake = Baby’s weight * 150 ml

150 ml is the minimum amount of milk per kg doctors used to decide IV fluid cut. If the baby can take more during her stay, this number might be increased to 165 if the baby is fed with formula, and to 200 if the baby is fed with breastmilk. These numbers obviously depends on the baby’s overall health. If the baby is well enough to nurse, these numbers do not matter at all.

For our case, IV fluid support was cut when Dora reached 1860 gram. It was her 30th day post birth. Her weight required 279 ml of milk with the calculation above and she was able to take all in. On the same day, we got upgraded to 3 hourly feedings:)

As there was no IV fluid anymore, PICC (a catheter inserted at her hand) was taken out of her hand which to us was a big milestone. No more worrying over possible infection caused by PICC and no more cables going through the hand. Cheers to that!

From the days, PICC was attached to D.'s hand