Jean
Great post on the 20% wt loss. I agree that is ALOT and not very likely to
be normal. I really appreciated your forthrightness saying you needed to
hone your telephone triage skills. I would love to be able to see all the
babies at day 3-4 but telephone triage is the next best thing I guess. I
agree with you that you have to ask very specific questions, somewhat open
ended, and leading a bit sometimes. Like you said asking the exact amt of
the pee and poo. I usually ask is it about a tsp or tbsp or more. Describe
the poo poo to me. Is the pee clear or very pale. Is the pee dark, tea
colored, or pink? I also ask if the baby has ever peed on the mom and they
usually say yes and I ask was it a good stream (a fountain) for a boy or a
good puddle for a girl, and they laugh and say yes! that is a good sign. If
they are not sure if the baby is peeing, or scant poop, bring them in. I
also ask about jaundice, if the staff told them the baby had some and what
to do, and if it appears more or less. (Beware parents are not good at
assessing juandice, lethargy, wt gain or loss etc IMO). There is alot to ask
and it is a judgement call really how they are doing. Sometimes it is very
clear they are doing well; sometimes it is very clear they are doing poorly,
and sometimes you are not sure. Sometimes I will give some recommendations
and call back next morning, sometimes bring them right in, sometimes
recommend supps of ebm/formula until can be seen. Coming from a hospital
setting and nicu background, maybe I err a little on the side of caution but
it has served me very well. Often catching babies that would have fallen
thru the cracks, as we say.
Today had a 36 wker now 4 days old who reportedly bf poorly 1st 12 hrs or
so, then was bf well (not seen by LC due to lack of w/e coverage). I
recommended she come in to be evaluated since b.wt was 5 lb 11 oz and
discharge wt 5 - 7 and baby was 36 wks and bf not evaluated by a skilled hcp
IMO. Today wt was 5 -3 and very jaundiced. Mom has been using hosp grade
rental pump but not getting much at all and the supps she was giving was
about 25% short of what baby needed each day. Called peds and sent to lab
for stat bili and peds visit. Luckily the baby was hydrated, alert, and
caught in time, I believe.
Just want to say as well that I appreciate Marie's points and also Tina's
'babies can latch by themselves' thread. I try to integrate all of this into
my practice which is art and science, remember, and sometimes it is a tough
call. Remember my motto: Live and learn.
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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