Dawn writes;
>>vaginal birth of twins at 35 weeks.
Weight went down to 4'6", is now back up to
around 5'.
Gavage
tube was removed on day 14.
Dr tells them he is too fragile to leave because he isn't feeding
well enough.
DR #2 diagnoses reflux.  Parents are trained on apnea monitor
and told how dangerous this condition will be at home (parents do not think
he has had an apnea episode in the hosp).  I found several studies that
indicate these two diagnosis don't necessarily go together.
Mom feels strongly that baby will do much better
when held by her, at home, next to his twin.  What sort of feeding criteria
could they be looking at? <<

Hi Dawn,
Based on the info. above it seems that the baby is now 37+wks, and is gaining
weight on all po (by mouth) fds.
 Whether or not he is still on a monitor MAY help to determine whether apnea
&/or bradycardia is considered to be a factor at this point. It may not
though as some hospitals seem to continue "monitoring" babies til dc'd.
 There are definite issues with communication here, as the parents should be
kept well informed about the babie's daily clinical status including what
needs to occur p/t discharge. You are absolutely correct in your deduction
that apnea and reflux can occur "in concert" but very often do not. Thus,
episodes of reflux don't necessarily require d/c with an apnea monitor.
The team meeting is a great idea. I'm not sure what, if any, research studies
would be applicable at this point. You don't really comment regarding their
(NICUs) support for establishment of brfdng ie. skin-skin etc..... and it
seems a little late for focusing on that anyway.
 I WOULD help the parents to be clear about their expectation for involvement
in the day to day care decisions regarding their baby and might also suggest
that if the Mom can arrange for child care for the 3yo, plan on bringing in
the twin and spending as much of the day as possible IN THE UNIT. This will
give HER a much better sense of whats going on and give the staff the message
that she wants her baby OUT! She might also want to involve her own
pediatrician as he/she can act as a buffer and interpreter of medical info.
OF COURSE she can always take her baby at any point, whether AMA or not but I
would want some questions answered first.
Good Luck!
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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