Christy Ann Flynn reminds us of the rationale for wanting to prevent and
treat hypoglycemia - it can in the worst case scenario result in permanent
damage to the brain, which needs very specific fuel for its metabolic
activity.
The problem is that our way of measuring what fuel is available to the brain
is indirect and incomplete.  We measure blood glucose, but we don't measure
ketones.  Ketones are not easily measured in blood.  I encourage everyone on
this list to get their hands on the most recent articles by Jane Hawdon et
al, on neonatal hypoglycemia.  They are among the references listed on many
of the websites about hypoglycemia.  Hawdon is a British neonatologist (and
incidentally, mother to at least one LBW, premature baby who was completely
BF from birth).
Hawdon and colleagues have looked at glucose metabolism in newborns given
breastmilk and formula, and found that it took longer for babies to achieve
stable regulation of blood glucose when they were given formula supplements
in response to low glucose measurements, than when they got breastmilk.
They had the opportunity in the research setting to measure glucose and
ketones, and found that the sum was pretty constant - even in those babies
we traditionally have assumed would not be able to mount a ketogenic
response to hypoglycemia: the premature or scrawny dysmature babies with
little subcutaneous fat.

I believe it was another research group which found a much higher insulin
level post-feed in babies given cow's milk formulas than in babies given
breastmilk.

I look forward to the day when these findings lead to the development of a
rapid, cheap test of blood ketones so we can give supplements more
appropriately than we do today.  It is too much to ask that NICU staff, who
are used to seeing disasters, should take it on faith that the formula could
be foregone in many cases.  They need to know that they are practicing
safely too.  They are used to seeing sick babies and are concerned about
avoiding more of them.  They have the best of intentions, however misguided
some of the interventions may seem to us.

There is currently no consensus on what the lower limit for acceptable blood
glucose is in the newborn.  There is also no evidence whatsoever that
routine monitoring of blood glucose in healthy term babies, even babies born
after hospital births in the industrialized world who may be hampered in
their ability to maintain homeostasis for many and varied reasons, has any
benefit whatsoever.  Parents have the right to know what evidence forms the
basis for any hospital routine at all, particularly any that interfere with
the physiologic process of adjustment to extrauterine life.

Staff need to know which babies to watch out for, and what the signs of
hypoglycemia are, and how to prevent or treat it appropriately.  Keeping
babies in physical, skin-to-skin contact with an adult (like father or
auntie if mother is unavailable) preserves the baby's glucose level.  How
many places have that as the standard of care until the first breastfeed has
taken place?  We separate mothers and babies and the very act of separation
imposes a huge metabolic burden on the baby.  We don't know what it does to
the mothers metabolically because nobody is checking but I am willing to bet
a week's pay that the effect on mother is measureable and negative.

Rachel Myr
about to go get some rest after 4 nights in a row, on a ward with term
babies, premies and dysmature babies feeding happily and on their own terms
at the breast, and a lot of smiling mothers :-))
Kristiansand, Norway

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html