The Term Infant with Problems: Management of newborns with poor weight gain

The management of infants within the first month of life with poor weight gain depends on the severity of poor weight gain. Protocols that may be used are given below.

For infants that are clinically stable and show cues for desiring a feeding, supplementation is optional.

1. These mothers need to have any problems with breastfeeding techniques corrected.

2. These mothers need to continue feeding at the breast and increase the frequency and duration of feeding.

3. These mothers need to express milk using an electric pump or hand expression between feedings. This will help increase maternal milk supply.

4. This expressed milk can be fed to the infant after the next feeding if desired, or frozen.

5. Weight should be monitored every 2-4 days and a weight gain of 20 gm/day should occur. If weight gain does not occur, proceed to the section below.

For infants with more critical weight loss, supplementation is indicated.

1. These mothers need to have any problems with breastfeeding techniques corrected.

2. These mothers need to continue feeding at the breast and increase the frequency and duration of feeding.

3. These mothers need to express milk using an electric pump or hand expression between feedings. This will help increase maternal milk supply.

4. This expressed milk should be fed to the infant after the next feeding. The amount of milk supplemented should start with 50 ml/kg a day divided among 6 to 8 feedings. If the mother does not produce enough milk for supplementation, formula should be added. Supplementation should be done in a physiologic manner (see section on physiologic supplementation).

5. Weight should be monitored every two to four days and a weight gain of 20 gm/day should begin by three to seven days. The amount of the supplements can be adjusted to assure that the infant is gaining at least 20 gm/day.