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Nicole Rouvinez Bouali

Pediatrics | Neonatal-Perinatal Medicine

Dr. Nicole Rouvinez Bouali is a top Neonatal-Perinatal Medicine Specialist in Ottawa, . With a passion for the field and an unwavering commitment to their specialty, Dr. Nicole Rouvinez Bouali is an expert in changing the lives of their patients for the better. Through their designated cause and expertise in the field, Dr. Nicole Rouvinez Bouali is a prime example of a true leader in healthcare. As a leader and expert in their field, Dr. Nicole Rouvinez Bouali is passionate about enhancing patient quality of life. They embody the values of communication, safety, and trust when dealing directly with patients. In Ottawa, Ontario, Dr. Nicole Rouvinez Bouali is a true asset to their field and dedicated to the profession of medicine.
30 years Experience
Nicole Rouvinez Bouali
  • Ottawa, On
  • UNiversity of Lausanne, Switzerland
  • Accepting new patients

My baby is unable to digest formula milk. Is it normal?

Breast milk is the easiest milk to digest, and includes protective elements that are not present in formula milk, like lactoferrin, and especially maternal antibodies that no formula READ MORE
Breast milk is the easiest milk to digest, and includes protective elements that are not present in formula milk, like lactoferrin, and especially maternal antibodies that no formula can give. It recommended to give strictly breastmilk up to 4 and 1/2 months, then to introduce progressively other nutriments. Make sure to sleep enough, exercise regularly, that you drink a lot and eat enough of a well balanced diet, and that your baby goes to the breast every 3 hours, up to 4 hours at night. Your baby should settle after the feed and sleep for 2-3 hours in-between feeds if well fed. Fennel tea, almonds and other natural food are good to stimulate lactation and your doctor can give you more advice if your milk production does not increase with those. If you eat/drink lots of dairies, you may also consider cutting a bit on those. You can also try to express your milk manually or with a pump that you will find in pharmacies - this will inform you on how much milk you produce, and will also stimulate your production if you do it every 3-4 hours for 5 minutes each side after your baby has gone to the breast - your brain will interpret that your baby needs more food and increase the production of lactation hormones. Usually breast milk production does self-regulate according to the baby's demand, but this may be impaired, especially in case of previous surgery on the breast, and few women just don't get enough milk despite trying. Formula milk is based on cow milk, and the casein in the cow milk is known to create intolerance, with the most severe form being cow milk protein allergy (CMPA), which usually presents with increased spits-ups, loose stools (but not always), possibly blood in the stools, poor weight gain and abdominal discomfort. If your baby presents poor weight gain and bloody stools, I recommend that you consult your doctor to rule out other causes of intolerance. There is unfortunately no specific test to confirm CMPA and exclusion of cow milk proteins is sometimes needed to document improvement, which can take up to 2 weeks to happen. If your baby has spits up and constipation, it can also just be that formula milk is more difficult to digest and is known to make more solid stools. Every regular cow-milk-based formula contains casein. Make sure you put the right proportion of formula powder in the preparation, as if it is too concentrated, it is even more difficult to digest and makes more constipation. Sometimes changing the milk to a lactose-free formula may help. if your baby has real CMPA, you would need to go on a dairy-free diet, or he/she will need a special formula like Alimentum or Neocate, in which casein is hydrolyzed, or even more elemental formula. Those are much more expensive though and are often not available in pharmacies.
Again, I can only encourage you to keep breastfeeding, as it is simply the best food for your baby.
Best luck with your breastfeeding!

Are preterm babies more prone to infections?

Yes, this is true. Like any other system/organ, the immune system is immature in the preterm baby, and slightly immature even in the term baby, but will then get more competent READ MORE
Yes, this is true. Like any other system/organ, the immune system is immature in the preterm baby, and slightly immature even in the term baby, but will then get more competent as your baby grows and gets exposed to environmental agents and microbes, which is a "normal happening" and makes us more resistant to infections by boosting our immune system. There are also some exceptionally rare cases of congenital or acquired immune disorder, in which case the baby/child will need more protection.
Most infections are carried by hand or by contaminated food. I recommend hand disinfection before feeding your preterm baby, and feeding your baby only breast milk as it includes natural defense components like immunoglobulins and lactoferrin, which promote the baby's gut well-being and natural defense. Putting your baby skin-to-skin- on your chest (mom or dad especially) will allow you not only to bond with your baby, but also to share common bacteries which will help your baby establish a normal and protective skin and gut flora.
Extremely preterm infants still hospitalized are at increased risk of infection as they often need intravenous catheter or ventilation support equipment, which may be contaminated by hospital resistant bacteria - but the neonatal team of your hospital will provide you information on those risks if this is your case.
I hope this helps.

Why is my baby unable to feed properly?

It may be because your baby was bottling your expressed breast milk while in hospital and discharged home before having "trained" to drink directly at the breast. If this is the READ MORE
It may be because your baby was bottling your expressed breast milk while in hospital and discharged home before having "trained" to drink directly at the breast. If this is the case, you can just continue to put your baby at the breast at each feed, as drinking at the breast may be a bit more difficult initially for some babies, but this is usually only transient and once your baby has the proper position at the breast the breast-suction reflex should come back. Before your baby is able to feed completely at the breast, continue to express your own milk and give it to your baby after he/she has has gone to the breast to satisfy his/her hunger, preferably with a cup instead of a bottle as the cup does not usually interfere with drinking at the breast. You can ask if the lactation consultant from your hospital can give you advice on tools to breastfeed successfully. Your baby also probably had a fortifier added to your expressed breast-milk while in hospital, which may change the taste of the milk, but he/she will get used to the taste change and you should be able to continue breastfeeding if this is the case. Your baby also needs a bit of time to get used to his/her new environment and time schedule at home. Also make sure you have a healthy life with lots of sleep, a healthy diet and that you drink a lot to keep your milk production up to your baby's demand. If you are stressed, your baby will sense it and may not feed and/or sleep as well. You can also ask an association of parents of preterm infants or simply your friends with small babies their trick to make a successful transition to home, as it is a real challenge to leave the hospital reassuring setting with a preterm baby!
Best luck with your breastfeeding!

Do preterm babies always have late development issues?

Most preterm infants actually have a normal life, with fully normal or near normal neuro-development, and this will likely be the case if your baby needed an incubator for only READ MORE
Most preterm infants actually have a normal life, with fully normal or near normal neuro-development, and this will likely be the case if your baby needed an incubator for only 3 weeks. Things that may affect long term development are severe suffering around the time of birth, documented severe brain lesions (severe bleed or lesions due to lack of oxygen), severe post-natal disease like severe infection or necrotizing enterocolitis (a severe complication at the level of the gut), or the need for prolonged mechanical ventilation. Developmental impairement risk is inversely proportional to the degree of prematurity, and is more significant in preterm infants below 29 weeks of gestational age. After that age, the risk of long term problems is much less, even though the risk of cerebral palsy (motor problems) is still slighlty increased up to 36 weeks gestational age compared to full term babies, in which it is extremely rare.
Your family physician or pediatrician will follow routinely your child developmental milestones. If there were any problem with your child's development, he/she will refer you to physiotherapy, ergotherapy or a speech specialist, which will maximize the chances of your baby to reach his/her full developmental potential. but again, if your baby only needed an incubator and no other life-sustaining support, the likelihood is that she/he will be perfectly fine!
Have fun with your baby!

My daughter is 1 month old and her stool is starting to look different. Should I be concerned?

No, this is a normal thing. Are you still breast feeding? Or did you change her diet recently? As long as your baby girl is feeding well, gaining weight regularly, happy and alert READ MORE
No, this is a normal thing. Are you still breast feeding? Or did you change her diet recently? As long as your baby girl is feeding well, gaining weight regularly, happy and alert when awake, and sleeping well in between feeds, you should not be worried. If this is not the case, or if the stools are black or bloody, I recommend that your take her to see her doctor.
I hope this helps.

What are the multivitamins to be given to a 6 weeks old baby?

The only supplement your baby should receive if you are breast feeding is Vitamin D. Breast milk has all the ingredients your baby needs if you consume a normal healthy diet. READ MORE
The only supplement your baby should receive if you are breast feeding is Vitamin D. Breast milk has all the ingredients your baby needs if you consume a normal healthy diet. (If you feed your baby formula, vitamin D is already added). Later on, your baby will also need supplemental iron to prevent toddler's anemia.