I apologize firstly if this has already been brought up. I did some
searching but didn't find anything recent.

I have a mom who is being discharged today. She had spontaneous ROM at 36
weeks/2 days and baby was breech in presentation so she got a section, DOB
was 1-9-08

Baby was 5 lbs 5 1/2 ounces, his APGARS were 8 & 9. He initially had some
issues with hypoglycemia but it is resolved now.

I checked the ABM protocol for near term infants and it recommended using
the LATCH or IBFAT scoring on these infants. I scored him a 5 on the IBFAT -
2 for readiness and 3 for rooting but this infant does not latch or suck
effectively. I did a digital suck eval and the suck is disorganized and
ineffectice (more "chewy" than anything). He does not extend his tongue out
past his gumline for latch. (Checked for tongue-tie, none found)

We did an SNS and baby took 5cc supplement that way but mom is definitely
more comfortable with the bottle. Baby has typical near term behavior at breast.

Dr dc'd mom today saying just offer the breast and if he doesn't eat, feed
him a bottle. So, I spoke with Dr and we agreed on supp amnt of 10-30 cc.
And, we're getting mom a pump rental from WIC. But, she has not been
committed to pumping and has not been doing so despite my telling her the
importance.

Questions:
-Is using the IBFAT an acceptable tool for clinical use? I saw a study from
Riordan back in 1997 but could not find anything more recent and used it
since the the ABM protocol suggested it's use, I did.

-Any thoughts or suggestions for me on management of this case? Home visits
are really out of my SOP but I could meet her for follow-up at the doctor's
office.

Thanks and best wishes!
Shana Hartley, RN, CLC (aspiring IBCLC) and MOM
Northeast Oklahoma, USA

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