Dear Everyone,

Thank you very much to those of you who have responded with your thoughts!
 I am happy to share this update on the case of the dyad who suffered from
maternal gestational acute fatty liver disease:

My last update was on 5/22 - at that time I was worried whether the baby
was getting enough caloric intake because the baby was generally rejecting
the bottle and not breastfeeding as frequently as I would have liked to
see. 5 pees and 1 poo in 12 hours. Baby was not as fussy as before, but I
did not know if that meant baby was becoming weaker, or feeding better.
 (To date I still have not seen them in person as I seem to have caught the
really bad cold going around this season and have been coughing my head off
with a really sore throat, so continue to talk with her daily by phone).

Baby got a vaccination and was weighed at 2760g, showing a gain of 160g
since 5/22 (but 2 different hospital scales).

On 5/23 - Baby had a vaccination the day before and was fussy all morning.
9 breastfeeds, only took 10 ml ABM total. 1 big poo, 12 pees (using cloth
diapers).  Mom says baby seems to suck longer at breast (more than 10
minutes per side now), and she feels like she has more milk.  She tried a
tube at breast three times but baby rejected the tube -- shaking head,
cries, avoids it, spits out.

I talked to her about getting under a physician's care, and although mom
could not figure out where to go to get regular care from the same doctor
who is supportive of breastfeeding, she said that her auntie is a pediatric
nurse and is at home with her now, able to observe them every day.  Her
assessment is that baby is doing much better than when first discharged -
better color and energy.

Mom says that baby does not even like EBM in a bottle - just sucks a few
sucks and then spits it out. If she keeps trying, baby starts to cry.  She
has tried all kinds of nipple shapes and materials.  But generally mom is
feeling less anxious than a few days ago, just more tired and spacey due to
lack of sleep.  Her main concern was how to get baby to not fall asleep so
quickly at breast. I asked how much clothing the baby has on. She said 2
layer of clothes, a receiving blanket, and a baby quilt.  I recommended
that she take off at least a couple layers and to keep trying to stimulate
baby.

I also recommended that she try to get the baby weighed in 2 more days,
feed 4 breasts each time if baby will take, keep expressing after feeds as
she has energy/time, no water so the diaper count is not affected, and try
to feed in comfortable positions so mom can sleep. Mom still resistant to
trying SNS.

On 5/24, baby breastfed 6 times (around 20 minutes each time), had 7 pees,
2 poops.  Mom expressed 4 times and got about 100 ml total.  On that day,
baby took about 60 ml EBM and 170 ml ABM from a bottle.

On 5/25, baby breastfed 9 times, took 110 ml ABM/EBM. She expressed 4 times
and also got 100 ml.  Baby had 6 pees and 2 poops.  She feels like her
breasts feel more firm now versus always soft before.  Mom says baby seems
attentive and doing well, but sometimes still sleepy when feeding.

On 5/26, baby breastfed 9-10 times, had 10 pees, 2 poops, and took 10ml
ABM.   They got a home electronic baby scale and baby weighed 2890g,
showing a gain of 130g the last 4 days, and 290g over 8 days!  (weights
from three different scales).  I know this is still baby catching up to
where she is supposed to be as she was below birthweight as NICU discharge
at 2.5 weeks old, but the gain seems very good.

5/1 Birth 2700g
5/18 Discharge from NICU 2600g
5/22 at vaccination 2760g
5/26 at home 2890g

I must say that I have never seen someone go from no milk to full supply in
10 days.  I am really amazed and I think it is a miracle.  I was concerned
that the poops weren't quite enough, but unless the scales are grossly off,
the baby seems to be gaining well despite not taking very much supplemental
milk!

I will keep monitoring her situation and share updates. Please share any
tips you may have, any suggestions on what else to watch closely. Thank
you, and I hope this has been of value to you.

Ivy Makelin
IBCLC, LLL Leader
Beijing China

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome