I was happy to see the references to some of Jane Hawdon's earlier research
in the list Katherine provided on hypoglycemia prevention in breastfed
babies.  Hawdon is the author of a very good paper from last year on the
same topic.  I don't have the study readily at hand but I'm sure it can be
found through PubMed; I think it was published in Pediatrics.  They measured
blood glucose AND ketones, and found that the sum was nearly constant.  If
glucose was down, ketones were up.  Unfortunately there is no cheap and fast
test for ketones in clinical practice.  They also noticed that babies who
were given artificial milk to bring up their blood sugar levels, seemed to
take longer to acclimate to maintaining normal levels on their own (boy do I
hope I am recounting this correctly!).  The gist of it as I understood it
was that it seems to be beneficial in many ways to avoid feeding anything
but colostrum/human milk, even in low birth weight babies, in the early
hours and days.

Last week I had a minor scare when a baby who had gone home at 48 hours
without ever really latching or suckling, came back for a bilirubin check
and PKU at 96 hours.  She had lost about 7% of birthweight by discharge, and
then nearly another 5% at this check.  Turns out she was not latching, and
mother was trying to spoon feed her and had managed to get a bit more than
half an ounce into her that way on only one occasion.  Otherwise she was
only taking drops, really, and parents were having to wake her for every
feed.  Mother had plenty of milk and was pumping regularly.  I encouraged
them to shoot for about 500 ml in the next 24 hours, and they were shown
finger feeding and advised to just feed the baby until we could weigh her
again the next day.  She had taken 260 ml by then, and that was quite
accurate as she was taking it all by fingerfeeding so there was virtually no
loss.  She had stooled three times, one of them in my office.  Her weight
had also gone up by 110 grams (which is about what 110 ml. weighs).  In
order to effect such a weight gain with formula she would likely have needed
a full 500 ml because so much of it is wasted in digestion and metabolism.
We didn't measure a blood sugar; I really didn't want to know what it was.
Besides, she was rousable and seemed fine when she was awake.

Rachel Myr
Kristiansand, Norway

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