I imagine this mom's milk supply is very low after 8 weeks of 
inefficient feeding, so expressing after the baby has an opportunity to 
feed is helpful. Positions that help the baby handle flow (mom reclining 
and baby on her belly with her head tilted gently back) can help as 
well. Making the breast constantly available might also be helpful once 
mom's milk production is improved and the baby's strength restored by 
feeding her however she can manage (baby in sling on mom's bare chest, 
mom can wear a lightweight shirt over the sling if she needs to). I've 
had several babies with cardiac defects in my practice thrive this way.

  I agree with Laurie that the first step is to see if baby is 
transferring too little milk, or is taking a normal amount but 
insufficient to meet an elevated metabolic need. I'd bet that both are 
happening. Modifying bottle feeding so the flow is slowed or using a 
flow controlled bottle like the Bionix controlled flow baby feeder may 
also allow the baby to get more milk with less stress.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 8/21/2012 1:48 PM, Laurie Wheeler wrote:
> This sounds like a very sick baby. First, I would want a pediatrician who is going to be very proactive getting baby evaluated and treated, coordinating the subspecialties, and being bf-friendly, if at all possible. I think waiting 2 wks to be seen is too long!
> Then I might do one or more pre/post feed weights to see what amount of milk baby is transferring, which I assume to be very low. Baby's with cardiac defects also can be using more calories to feed, breathe, so that is a factor too.
> Therefore, even without the test weights, I would have mom expressing milk as often as she can, and supplementing baby with all ebm (and perhaps abm if needed for low volumes) either by bottle or lactation aid, whichever I assessed to be easiest for baby to take in more milk. I would detail for mom, based on pre/post wts and what she can express, how much to feed the baby and how often. The baby may actually not be able to manage "at the breast feeding" right now. This baby needs calories. I would schedule frequent wt checks and support of course.
> While preserving the breastfeeding relationship is certainly extremely important (and I take that to mean "at the breast feeding"), this baby's need for calories seems to take precedence over this "at the moment."
>
> Opinions expressed above are not necessarily those of Baptist.
> Laurie Wheeler RN MN IBCLC - Mississippi USA
>
>
> Baptist 100. Well beyond a century.
>
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