There is no right answer to this, but whatever the answer you choose,
part of the protocol should be to start expressing milk (hand
expression is often more successful for small amounts than pumps)
before supplements are given. By the way, what is this mania for
having a particular time? Might the situation of one baby not dictate
early feeding, while the situation of another allow for sitting tight?
I believe strongly that at 5 hours or 24 hours, any supplement to be
used, except under extraordinary circumstances should be in the
following order of preference:
1. colostrum
2. colostrum mixed with sugar water
3. banked breastmilk
4. sugar water
Supplements should be used *at the breast* with a lactation aid unless
the baby fails to latch on, but only after improving the latch and
using compression does not get colostrum into the baby.
Formula is rarely necessary during the first 2 or so days, except to
treat symptomatic hypoglycemia and even then only if there is no
colostrum (which is preferrable by far over formula) or banked
breastmilk available and sugar water doesn't treat it. Sugar which is
dropping so rapidly that you don't have time to try these things
first, needs IV correction.
There is no need to do dextrostix on a baby that does not feed just
because he hasn't fed for 5 or 12 hours or whatever. One of the
points in the recent paper put out by WHO on hypoglycemia is that
"Healthy term newborns do not develop 'symptomatic' hypoglycemia as a
result of simple underfeeding." The full text paper also goes into
great detail on how the dextrostix is inaccurate.
Finally, remember that not that many years ago, there was a routine in
many hospitals that babies were not to be fed for the first 24 hours!
This was a stupid policy, but the roof did not fall in, though
obviously this was not good for babies, or mothers, or breastfeeding.
In my humble opinion, the "Immediate Postpartum Breastfeeding Decision
Tree" is a good starting point for policy on breastfeeding (see June
1996 JHL).
Jack Newman, MD, FRCPC
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