Before-and-after weights for premature babies

Can I use before-feed and after-feed weights to see how much milk my premature baby takes from the breast?

Premature babies often breastfeed ineffectively and don’t show hunger signs. Before-feed and after-feed weights can be useful for these babies. They can show whether the baby is learning to breastfeed or whether the baby takes in more milk with a nipple shield. They allow mothers to see what breastfeeding behaviours result in higher milk intake. Premature babies usually take in small amounts, so it is important to pay attention to details when weighing. The baby should be calm and ideally not wrapped in a blanket. Nothing should hang over the edge of the scale and no clothing or diapers should be added or removed between weighings. If a baby is very poor at breastfeeding or is breastfeeding effectively and growing well without milk supplements, there is no point using before-feed and after-feed weights.

A) Describing premature babies’ breastfeeding challenges

Very premature babies often do not breastfeed effectively. Unlike healthy full-term babies, they may be unable to give hunger signs, making it hard to know how much milk they take from the breast. This information can be obtained using before-feed and after-feed weights (before-and-after weights), and their use improves breastfeeding outcomes (Maastrup et al. 2014; Meier and Engstrom 2007; Rankin et al. 2016).

Your health-care providers will help you with this if your baby is hospitalized. Breastfeeding specialists can be very helpful in this situation.

B) Reasons for before-and-after weights for premature babies

Before-and-after weights for premature babies can be used to:

  • See if the baby is developing the ability to remove milk from the breast.
  • See if the baby takes in more milk with a nipple shield.
  • See which size of nipple shield is most effective.
  • See if breast compressions result in the baby taking in more milk.
  • Allow mothers to see what breastfeeding behaviours result in higher milk intake.
  • Support babies at home by:
    • Guiding mothers in decreasing supplements. 
    • Identifying a low milk supply.

Mothers of hospitalized premature babies are sometimes asked by health-care providers to use before-and-after weights to see how much milk their premature baby is taking from the breast. This is a way of measuring how effectively the baby is breastfeeding and helps providers know how much milk to give the baby as a supplement and how quickly to remove other supports such as feeding tubes.

If a baby is premature, it is important for mothers to express after every feeding to:

  • Continue producing milk.
  • Obtain breast milk for the baby’s supplement.

C) Doing before-and-after weights when the baby is premature

To see how much milk a premature baby is taking in, the baby should be weighed before and after feeds for a number of feeds as intake can vary greatly between each one (Perrella 2020).

Premature babies usually take in small amounts, so it is important to pay attention to details when weighing. Before-and-after weights may be inaccurate when:

  • Babies are not calm when weighed.
  • Different blankets are used at each weighing.
  • Items such as wires or blankets hang over the edge of the scale.
  • Clothing or diapers are added or removed between weighings.

 Ideally, the baby is weighed without being wrapped in a blanket.

D) When not to use before-and-after weights for premature babies

If a baby is very poor at breastfeeding, there is no point using before-and-after weights because the baby is taking in only tiny amounts and the amount will not affect the amount of milk supplement the baby needs.

Once babies are breastfeeding effectively and growing well without any milk supplements, there is no need to use before-and-after weights. The normal growth is the proof that the baby is getting enough milk.

References

Maastrup R, Hansen BM, Kronborg H, et al. Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study. PLoS One. 2014 Feb 19;9(2):e89077
 
Meier PP, Engstrom JL. Test weighing for term and premature infants is an accurate procedure. Arch Dis Child Fetal Neonatal Ed. 2007 Mar;92(2):F155-6

Perrella SL, Nancarrow K, Rea A, et al. Estimates of Preterm Infants' Breastfeeding Transfer Volumes Are Not Reliably Accurate. Adv Neonatal Care. 2020 Oct;20(5):E93-E99

Rankin MW, Jimenez EY, Caraco M, et al. Validation of Test Weighing Protocol to Estimate Enteral Feeding Volumes in Preterm Infants. J Pediatr. 2016 Nov;178:108-112