Brief Answer:
We have to screen for treatable causes

Detailed Answer:
Hi Visha,
I understand your concern

Firstly, when assessing weight of a preterm baby, we have to use the corrected age. Here, the baby was born at 26 weeks, and hence we expect his present weight to be that of child 14 weeks younger than him(around 7 months). Even then, his weight is lower than expected(we expect around 8 kg by 7 months).

Many pre terms will have difficulty in gaining wait for initial few months, and they will usually make it up by 2 years of age. Reasons for too inadequate weight gains are many, some being any congenital anomalies, neurological issues like seizures, inadequate calorie intake, improper feeding, recurrent infections, and anemia. If any correctable causes are identified, we can rectify them. If no such factors are obvious, we need not worry if he is active, playful and having a normal development. So kindly give me few more details to assess for any underlying causes:

1. How long he was on ventilator and oxygen support initially?
2. Any congenital malformations like congenital heart disease or facial dysmorphism identified?
3. Had he any episodes of low blood sugar, jaundice requiring blood transfusion or sepsis(infection)?
4. What all food items you are giving him now, and how often?
5. What about breast feeding and formula feeding(which formula)?
6. What all vitamin and supplements he had received, and still receiving?
7. Had you checked his hemoglobin level recently?
8. Any significant illness or hospital admission after newborn period(especially pneumonia and diarrhea)?
9. If possible, send me his newborn discharge summary including report of ECHO and brain scanning if any.

This may feel a bit cumbersome, but we need to find out what all things can be done to bring him up. Kindly get back with details, so that I can guide you better
Dr Muhammed Aslam, Paediatrician

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Brief Answer:
Need not worry

Detailed Answer:
Hi dear,
Thanks for the information given
From the details given, conclusions and recommendations are:

1)Diet: He is getting a reasonably good diet. Few things can be done to improve calorie delivery and quality of diet- (A): try to increase number of major meals from 3 to 4 per day. (B): adding a bit more oil/ghee/sugar while preparing food will increase the calorie density, allowing more calories with same volume. (C): try to slightly increase the amount of protein(meat, fish, egg, dairy, pulses) in food while ensuring tolerability and palatability. (D) While preparing formula, ensure that dilution is as recommended. (E) Restrict amount of plain water by replacing it occasionally with rice water or similar drinks. (F) Avoid or restrict caffeinated items(tea, coffee, chocolates).

2)Underlying causes: From your description, probably he had some chronic lung issues(broncho pulmonary dysplasia), requiring long term oxygen and steroid support- this can restrict weight gain initially, as more calories are utilised for work of breathing. Also, initial weeks spent on intensive care will cause delay in beginning of nutrient assimilation.

3)As of now, since he is active, playful and having normal development, let us not worry much. Try the above said measures, and let us recheck weight after 4-6 weeks. Normally, we expect around 350-400g gain in one month. If weight gain is still inadequate, we can do a hemoglobin level and peripheral smear to look for anemia(pre term babies can develop anemia even while on iron supplements). Also, doing a thyroid function test will be good then(TSH, Free T4). Anemia and hypothyroidism can cause delay in weight gain.


Hope I have addressed your concerns
If you need further clarification, I will be happy to help.
Dr Muhammed Aslam, Paediatrician

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Brief Answer:
Yes, you can

Detailed Answer:
Hi Visha,

You can add sugar to diet, adjusting to babies taste and comfort. Even if bay food contains sugar, this will not cause any harm. This is one method of increasing calorie density.

Cerelac is a commonly used complimentary food for infants. This is cereal based, and you can use this very well.

If you have no further queries, you can close the thread and rate the answer.
Wishing good health
Thank you

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