Welcome to the Fortified Family! I’m Katie Ferraro, Registered Dietitian Nutritionist and mom of 7 and I specialize in baby-led weaning. I’m passionate about feeding strong families and making food fun.

Feeding the World's Smallest Baby

Feeding the World's Smallest Baby

Disclaimer: This post is sponsored by Sharp Healthcare.


News of the world’s smallest baby ever to survive - Baby Saybie - has been circulating for a few weeks now.

If you missed it, Baby Saybie - the name given to her by her care team at Sharp Mary Birch Hospital for Women & Newborns in San Diego - weighed only 245 grams - which is just over 8 ounces (a half-pound!) when she was born at 23 weeks gestation, a full 3 months earlier than planned. (You can read Baby Saybie’s amazing birth story here).

Baby Saybie at Sharp Mary Birch Hospital

Baby Saybie at Sharp Mary Birch Hospital

My family is very familiar with the hospital and Neonatal Intensive Care Unit (NICU) where Baby Saybie received her life-saving care. This is the same NICU where our quadruplet babies Charlie, Claire, Henry and Dillon spent their first few weeks of life! Our experience began 3 years prior to Baby Saybie’s arrival.

The quadruplets were born at 34 weeks gestation and each weighed between 2 and 3 pounds when they were born at Sharp Mary Birch. The quads went right to the NICU and stayed there for help eating, breathing and growing until they started going home one by one, and thankfully not all at once!

{If you want to hear more about our incredible experience before, during and after the quadruplets’ delivery, Sharp Healthcare featured us in their Sharp Experience documentary series “Defying the Odds with Quads” which you can view here.}


Pre-Term Babies Need More Nutrition

It’s hard to even fathom the magnitude of what keeping a 23-weeker alive entails. And then just think about the incredible team of professionals who got her to the point where she could go home and be with her family 5 months later!

With pre-term a baby misses out on a lot of the important developments that should occur in the latter stages of pregnancy. Because of this, optimal nutrition for pre-term babies is extremely important.

I recently had a chance to learn more about neonatal nutrition from the incredible clinical team at the Sharp Mary Birch Hospital NICU here in San Diego. This is the largest unit of its kind in California, so they know a little bit about lifesaving nutrition interventions for tiny babies!

If your baby is a preemie, here are a few of the basic nutrition guidelines your care team will implement during baby’s time in the NICU…many of which are the same we experienced during the quadruplets’ NICU stay.


Primary Goals for NICU Nutrition

It’s kind of a mouthful, but per the American Academy of Pediatrics Committee on Nutrition (AAPCON), the goals for very low or extremely low birth weight infants is “the achievement of postnatal growth similar to the intrauterine growth rate of a normal fetus at the same post conceptional age.”

Basically, the care team in the NICU is working to make sure baby on the outside is getting what baby on the inside WOULD have been getting at this stage if baby were still in utero.

The neonatologist physicians, registered dietitians, pharmacists, occupational therapists, physical therapists, nurse practitioners and nurses are all working with the pre-term baby to:

  • Maintain and develop lean body mass and bone density

  • Optimize neurodevelopment and growth

  • Prevent or offset complications like chronic lung disease, necrotizing enterocolitis and infections

At the same time they’re working towards optimizing nutrition to prevent later in life complications that all babies can be at risk for later in life, such as diabetes and obesity.


What About Breastfeeding Preemies?

I knew pre-term birth was all but certain with my high-order multiple pregnancy (quadruplets). Full term pregnancy is 38-40 weeks. The average gestational age for quadruplets is 28 weeks. So I was over the moon to go 34 weeks with my quads, which is as far as my high risk OB felt was safe before we had a scheduled C-section at Sharp Mary Birch Hospital.

One of the many reasons we chose Sharp Mary Birch for this high risk delivery and post-natal care is because they are now a designated baby-friendly hospital, meaning the entire staff is trained to provide the support, education and confidence to help you achieve your breastfeeding goals.

I knew my babies would be born early, and I knew that optimizing their nutrition to help them eventually “catch up” would need to start the day they entered the world.

As an exclusively pumping mom (…no way I could manage breastfeeding 4 at once!) I felt totally supported during my time at Sharp Mary Birch. I have delivered all 7 of my children at this hospital, starting with my oldest, a full-term singleton.

With the quads, everywhere I turned staff in the NICU were there to ask me how it was going, “What do you need to help achieve success with your milk supply?” …“Do you want to use the private nursing lounge to pump?” …“Do you want to meet with the lactation consultant again?”

The Sharp Mary Birch NICU staff were so positive and concerned about my babies’ nutrition, that I really don’t think I could have made it 10 months pumping for 4 babies if it weren’t for their initial encouragement and support!

I always had to supplement my breastmilk supply with formula, but as a Registered Dietitian, I do know that a lot of their catch-up growth and current status as healthy, thriving toddlers is attributed to the excellent nutrition care the quads received early on in the NICU, from the combination of breastmilk, to fortified formulas and nutrient supplementation.


Supplemental Nutrition Needs

In the NICU, mom is encouraged to pump breast milk early and often - at least every 3 hours.

You’re tired and exhausted and worried about your baby; but I actually liked pumping because I felt like it was the one thing I could do to help my babies.

Despite all of these efforts, my breastmilk supply only ever met half of the quadruplets’ needs. They had feeding tubes, I needed donor milk and additional supplements, but in some way - by pumping - I was doing a small part to help the babies get stronger and go home sooner.

Early intravenous nutrition is provided on day-of-life #1, containing all of the important nutrients these very tiny babies need.

Very small amounts of breast milk or donor breast milk are then fed through a feeding tube into the baby’s stomach by day-of-life 2 and 3 (in most cases).

Human Milk Fortifier (HMF) is added to breast milk shortly after plain breast milk is tolerated. Fortifiers give baby extra protein, calcium, phosphate, vitamins and iron to the infant diet.

At the Sharp Mary Birch NICU, all breastfed and some formula-fed babies receive a vitamin D supplement in addition to fortified breastmilk per AAP guidelines for pre-term infants.


Who Helps You?

There’s certainly a lot of stress associated with being in the NICU. But one thing I really loved was the around-the-clock support at Sharp Mary Birch Hospital.

We were terrified of taking 4 tiny babies home and being by ourselves with them - but the hospital staff adequately “trained us up” during our time in the NICU.

At first we didn’t know what to do with the babies in the NICU. You’re scared to touch them, you don’t want to get in the nurses’ way, the babies are isolated in these little chambers, there are bells and whistles everywhere that are freaking us out but nobody else seems stressed by.

It’s all a little strange…and intense. And then of course there are lots of families around with very sad stories, fragile babies everywhere and you’re just not sure what you’re supposed to do as an outsider in their world.

But very quickly it became OUR world too, and we got the hang of the NICU routine: call and say exactly when you’re coming, don’t show up during shift change :) …check in with the babies’ new nurse, take their temps, change their diapers, get busy feeding, rock, sleep, and start the whole routine over again.

I loved that Sharp Mary Birch paired us up with a social worker who was a triplet mom, and her advice about taking care of multiples was invaluable. We met amazing lactation consultants and NICU dietitians, attended a refresher CPR course hosted by the hospital and talked to every single NICU nurse we could get our hands on about how to maximize these babies’ health and wellbeing once we got home.

After weeks of the babies having had access to every state-of-the-art technology, intervention, equipment and highly trained neonatal healthcare professionals, on the way out with the last of 4 babies, our favorite nurse Kate gave us some really simple, sage advice about how you keep babies alive when you get home.

“Babies are pretty easy,” she told us. “When they’re hungry, you feed them…when they’re wet or dirty, you change them…when they cry, you rock and love them. You guys will be fine.”

Thank you to Sharp Mary Birch Hospital for bringing our beautiful babies into the world and taking care of them during their time in the NICU!

To learn more about Sharp Mary Birch Hospital for Women and Newborns - the only women’s hospital in San Diego County and the place that delivers more babies than any other hospital in California - click here.

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