Ann
It seems obvious to me that this baby has some underlying metabolic, 
chromosomal, or syndromic problem. Have all these things been ruled out? I 
would have baby seeing endocrinology and genetics, and developmental peds, 
if possible. Is it possible for baby and parents to be admitted to a 
faciliity where multi-specialties can see the baby and coordinate care?  If 
the baby can latch and suckle, can a supplementer be used at breast? Mom 
should be urged to protect and increase her supply as much as possible and 
can give hindmilk feeds if she can by spoon or supplementer. A test for CF 
does seem prudent. What about swallowing studiess? Does baby have any signs 
of respiratory symptoms? I hope Cathy Genna will comment on this case.


Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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