Sunday 3 November 2019

N EXCESSIVE WT GAIN

Excessive weight gain

Hi Guys 
Is there anything called excessive weight gain in a premature (25+5 weeker) infant who is now 54 days old. Having gone through longterm MV, difficulties in getting extubated, use of steroids etc she is stable on CPAP currently and gaining weight 60-90 grams/day, at 180mls/kg/day of EBM and full strength fortifier. Her growth on chart going like mount everest...Bloods are normal...Creatinine is normal, urea is 8.9 which has crept up a bit. She is auto warning on her diuretics (0.8mg/kg) because of weight gain. Since she is gaining weight so fast, she appears oedematous to some nurses sometimes... but obviously she is not, its just fat as linear growth is yet to happen. 
My question actually is.... is there ever a logic in cutting back their feeds because there is too much weight gain? Having worked in different set ups I have seen clinicians cutting back on milk feeds from 200mls/kg/day to 180 or from 180 to 165 because the baby is gaining lots of weight. 
Hi Schumz 
i would suggest cut down the feed volume at which infant gain weight around 20-30g/kg/day, you can even cut down TFI to 130ml/kg/day but you need to titrate it gradually. First cut fluids to 150ml/kg/day and then 130
Any added fortifier needs also to be reduced. 
Keep this in mind that chubby babies are not healthy. 
Also diuretics have no evidence in BPD, so I would also discontinue them
thanks

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