Premature baby: 29.5 weeks female Birth wt: 856 gm Weight now: 4.35kg NICU : for 9 weeks. Homecoming weight was 1.85kg Medical complications since birth: Had retinopathy of prematurity. Cleared by itself now. Was on ventilator for 1-2 days in beginning. Had mild apnea in earlier days of NICU. Medical complications after coming home: 1. Spit ups and vomiting: Almost 3-4 times in each feed, ranging from small quantity to almost whole of the feed. Few days and few feeds are better than others. Half of the times vomits even after 1-2 hours after the feed. Sometimes milk, sometimes curdled, sometimes coughy. Most of the time she coughs and takes out the whole of milk, feels like she aspirates. Sometimes with burp. Even when we lay her down after 2 hours of feed and pick her up, sometimes she coughs and then vomits. Sometimes I feel that milk comes back up to her mouth and then returns. 2. Burp and gas: She needs to burp atleast 3-4 times between feeds and that too multiple burps. Even after 2-3 hours of feed sometimes she needs to burp. She gets very uncomfortable and cries sometimes to burp. Even when she sleeps she gets uncomfortable and if we don’t pick her immediately, she vomits and if we pick her immediately she burps and sometimes spits up. 3. Gags: Gags and has vomitish expressions on her face even at empty stomach. 4. Weight gain: It was 4kg a month back and now it is 4.35. 5. Her sonography shows hypoechoic lesion in liver which pediatric ruled out as nothing major. But did once mention that medicines like perinorm are not good for it. Milestones achieved: Makes eye contact and makes sounds and smiles. Medicines administered: Where and when medicines feed remarks NICU 1. A to z : multi vitamin 2. Tonoferon: iron 3. Nutriright d3: d3 4. Vitcofol 5. Perinorm: metoclopramide 6. HMF 7. Simyl oil Was given pre-nan formula milk but mostly expressed breast milk. Was taking about 45 ml at the time of discharge Had no issues of vomiting or tolerating milk. Coming home Was stopped A to Z and simyl oil. perinorm for a week Was given pre-nan half and half expressed breast milk. Was taking 45-50 ml. Had no issues A week after coming home Was re started with perinorm and other medications continued. Also, ossopan D for calcium started. Was shifted to NAN1 Formula milk. Was given expressed breast milk3-4 feeds. Issues of vomiting started after the changes. Since then when more vomiting persisted, her ossopan d was discontinued within a week, and other medications stopped since 2.5 months now. Lot of medicine and formula changes have taken place since then only to notice brief improvement and after few weeks it gets worse. Medicine changes include, perinorm, ondem, domstal,motinorm,lanzol junior, omez. And formula isomil was tried too for a month. For a few weeks we saw improvement with isomil ( was on breast milk on half feeds) but weight gain was poor and then vomiting increased and got worse. Medication now: Lanzol junior 15mg (1/3 tab a day), Motinorm 0.3 ml thrice. Doctor has suggested ventorlin 1.5 ml thrice and wheat cereal to be mixed with milk, both of which have not been started yet. Condition improved for a few days with change but worse now. Is back on NAN1 and breast feed in only 1-2 feeds a day. Precautionary measures: We are keeping her in upright position (on shoulder) for 30 minutes after feed. Feeding her in upright position. Making her sleep on her back with mattress elevated at around 30 degrees. Questions: 1. What is her problem 2. Shall we try Enfamil AR or Similac spit up? Or some hypoallergic formula? Will it be good for her also considering she gags and aspirates and coughs even now? 3. Is gripe water helpful 4. Can we try giving her vegetable juice, pulses water or rice starch 5. If medications wont help, shall we stop them altogether. Side effects of these medicines? 6. Her feedings lasts for 45 mins to 1.5 hours because of her burps and gagging and being uncomfortable. We are feeding her anywhere from 2 ounce to 3 ounce every 2.5 -3 hourly (at night 4-5 hourly). When she used to feel good she easily used to take 4 ounce. She still looks hungry but we are too scared to feed her coz of overfeeding and vomiting. She even vomits if she is hungry and has just had an ounce of milk! What to do and how much to feed her 7. Her sonography shows hypoechoic lesion in liver which pediatric ruled out as nothing major. But did once mention that medicines like perinorm are not good for it. Is any of her medication harming her?