Dear Lactnetters,
I'm hoping someone can point me in the right direction with this.  I did go
to the archives but haven't been able to sort through posts well enough to
find exactly what I'm looking for.  Specifically this family has requested
research material that will support the position that their baby should be
discharged and that his feeding will be better at home.

I have permission from this family to post here.  As a doula I was present
on 3-15-02 for the vaginal birth of twins at 35 weeks.  Wonderful birth!
Baby 'A', a girl, weighed 4'8" and is doing fine.  She roomed in and was
discharged on day 2 or 3.  Baby 'B', a boy, weighed 4'14", had some fluid in
his lungs, was grunting and retracting with each breath.  Oxygen saturation
was low but came up nicely with oxygen.  After 4 1/2 hours he was transfered
to the NICU.  Mom pumped, he never recieved formula but was given glucose
and vitamin, minerals via IV.  Weight went down to 4'6", is now back up to
around 5'.  He was gavage fed for 5 or 6 days then allowed to breastfeed.
First few feeds weren't great, he'd latch but not suck, mom persisted and on
day 7 he began sucking in short rythmic bursts.  Also on day 7 his IV was
removed, was no longer kept on 24 hour oxygen and was maintaining his own
body temp without warmers.

Family lives an hour from the hospital, also has a 3 year old at home.
Travelled to hospital for 3 feeds per day the remainder were gavage.
Parents are told by one DR that baby is close to going home.  Same day
another DR tells them he is too fragile to leave because he isn't feeding
well enough.  Mom said "Okay, bottle feed him, discharge him and we'll fix
it when we get home".  Baby won't accept a bottle, I suggested some
strategies, something must have worked because he began taking the bottle.
Then, day 12, 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.  This family
practices some form of co-sleeping, baby bed is next to parents bed.  Gavage
tube was removed on day 14.

Mom has suggested letting her "room-in" with baby at the hospital (on
another floor obviously) for a while so she can feed on demand and still let
them monitor baby.  Staff dismissed this as a possibility.  Baby is being
fed on a 3 hour schedule (via bottle if mom cannot be there).  This is their
schedule not the mom's.  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?  The dad is so angry and frustrated he is beside
himself.  They get conflicting information from one RN to the next and one
DR to the next.  They are requesting a "team meeting" to clarify exactly
WHAT needs to happen for their son to be dc'd.  Any suggestions for (1)
research studies (2) specific questions to ask (esp. from those of you who
work in hospitals.

Thank you in advance,
Dawn Martin
Austin, TX

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