Esteemed friends - have just finished my busiest month ever, but seem to
have had an unusual number of nail-biting cases of babies "not getting
enough" in the first few days - absent lactogenesis (posted about this, milk
never did come in), severely inhibited let-downs - one with totally inverted
nipples, several who for some inexplicable reason did not pump as I had
urged for their sleepy babies, then became horrendously engorged, leaked
spontaneously but seized up the minute the pump or the baby came near them,
latest one a breast reduction, mother highly motivated, baby sucking
frequently and well.  Characteristics of babies have included - over 10%
weight loss since birth, low urine output, bilirubin levels going up to 17 -
2O, paediatricians either not believing me when I express my concern about
breastmilk intake, or away, or not available  (amazing how often this
happens on a Friday afternoon) - as I say, nail-biting!
All of these babies start passing "brick-dust urine" on Day 3 or 4 or 5
post-partum, however I worked with a case of FTT a while ago where the baby
was still passing pink urine on Day 19. One paed has told me he sees about 5
babies a week doing this, it's called "uric acid crystals", it's not blood,
don't worry about it. Another says he doesn't know what causes it.  A nurse
says it's very common.  No-one seems concerned. My observation is that I
only see these pink stains on the nappy (diaper) when the baby's breastmilk
intake is obviously inadequate (little swallowing, dozy babies or
frantically hungry babies, long feeding intervals, very low urine output).
The pink stains are sometimes mixed in with the urine, look like a little
sprinkling of "brick-dust" or, sometimes without the urine, look like big
shocking-pink blobs.  One mother who observed this happening while changing
her baby described it as "thick gunk".

My questions:

1.  What IS it?
2.  What causes it?
3.  Is it a symptom of inadequate fluid intake?
4.  What breastfeeding management strategies do you use when you see this?

Any and all technical explanations, personal experiences, suggestions,
advice, cautions and information will be very gratefully received (privately
or on Lactnet so we can all share) - this has bothered me for years!

Thanks if you can help.

Pamela, Zimbabwe