Hi All,
I work in both inpatient and out patient hospital settings and have been
following a dyad that has caused me to reflect, again, on the extremes of wt. loss
particularly in terms of at what point does a lg wt loss point to   more of
an emergency response.
The baby in question was delivered at 8-2, dropped to 7-6 before milk came in
(late, on day 6), rebounded up to 7-10 by day 20 but by day 26 (our consult)
had dropped back to 6-6, a loss of 20 oz in 6 days!! The baby was seen twice
by pedi (between day 8--20) with <1/2oz/day wt gain (on different scales) and
was not scheduled for a f/u for 2 weeks. Fortunately Mom called our *warmline*
for direction after baby had not stooled for 12 days (3 days after last pedi
apt) and they scheduled f/u with us. On exam the baby appeared cachectic but
voracious at the breast-practically inhaled it, thus she was alert and active!
We did supplement during the consult BUT I was worried about them after they
went home.....do we rely totally on the baby's clinical status (ie. alert and
willing to eat) to determine whether closer monitoring is needed or is there a
marker for wt. loss that should signal further w/u.... regardless of baby's
ability to eat?   I did (of course) call the pedi with the details. I assume that
this type of scenario is not as uncommon as we would hope.
Lynn Shea Rn, Bsn,Ibclc
Franklin, Massachusetts

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