Juanita, you wrote:  "I've just been contacted by telephone by a couple in Berlin, Germany whose
baby is losing weight - born 19 June at 3450g, now weighs 3090g, c-section, baby has received glucose water, mother has very supple breasts, can express a bit of milk manually. Stools are still dark meconium, slightly lighter since yesterday, urine seems pink apparently. Very sleepy baby."

Apart from the glucose water (why on earth?) everything in this case is exactly as I would expect it.  *Of course* the baby is losing weight, it's only 3 days old.  It's lost a hair more than 10% of its seemingly normal birthweight and stools are already lighter in color than they were yesterday.  I'd bet good money the pink urine is 'brick dust urine', also exactly what one would expect to see in a newborn on day 3 who has lost 10 % of birthweight.  That same bet says it will be gone within the next two days if they continue the skin-to-skin and hand expressing - and of course I am assuming every drop of expressed colostrum is going into baby's mouth.

The *only* thing glucose water will do in this situation is delay the baby's interest in the breast.  Of course if the hospital would give breastmilk substitutes if parents declined glucose water, IMO the glucose is the lesser of the two evils.  But I don't understand why anyone would be giving it in this situation (or any situation, really), and frankly I'm surprised that there is anywhere in Berlin providing what sounds like outdated care, I have more confidence in my German colleagues than that.

Unless this is a very large-for-dates baby born well before 37 weeks gestation, this would be a wait-and-see case in my book.  The baby should be followed closely after discharge if there is continued weight loss by tomorrow and weighed (naked) within 48 hours of going home, and parents should know what to expect to see (more frequent, lighter stools, a more alert baby who is cueing to feed frequently, and disappearance of pink in urine) if all is going well, and of course who to contact if it isn't.   They also need a plan for getting milk production established while they wait for baby to wake up.   It worries me that the parents are so concerned in what appears to be an unremarkable, everyday situation, because either the hospital is overly anxious or the staff are not communicating effectively with the family.  Either way, the breastfeeding may be jeopardized.

Rachel Myr
Kristiansand, Norway

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