Might I suggest another tack to take as you address your policies?  If I
understood you right, your staff is being forced to feed babies that haven't
latched on by 4 hours of age!  Unless you have a high population of preemies
or small-for-gestational-age babies, there can't be any justification for
doing this.  There would be hugely reduced numbers of babies "needing"
supplementation, I would assume, if your policies or doctor's orders were
really based on research.  If they're worried about hypoglycemia, there's a
LOT of interesting reading at
http://www.who.int/chd/publications/imci/bf/hypoglyc/hypoclyc.htm which is
the World Health Organization's review of the literature on Hypoglycaemia of
the Newborn.  This literature is what was instrumental at my hospital in
getting rid of the orders to routinely test LGA babies.  There's some
interesting research in there about studies in which babies were not fed for
as long as 72 (!) hours.  Perhaps if you present research for changing your
policies to allow for more latitude in feeding, you could dialogue with your
doctors--I can't imagine they could find research to support the current
policies.

Dr. Jack had a lovely flow chart in JHL some years back that we made slight
adaptations to and is now the official policy referred to in the doctor's
orders as to when to supplement.  We don't need to start feeding a normal
baby anything until 24 hrs., never do a glucose check on a non-high-risk or
non-symptomatic baby, and have had no problems at all.  Good luck to
you--perhaps some good will actually come of this; I can't imagine the
finger-feeding was at fault for this baby aspirating.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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