I cannot say strongly enough how much I agree with Cathy Genna's caution
that a visual assessment of milk transfer is not reliable for a compromised
baby.  It is evident beyond any shadow of a doubt that the baby is getting
insufficient calories/nutrients - there is virtually no growth going on.
What this baby has gained in 5 weeks is 10 ounces, for all you metrically
challenged folks out there.  That is about what we see healthy babies
gaining in a week where I work.  The baby is gaining about one third of an
ounce per day, and has been for 35 days.  Due to the increased metabolic
needs inherent to the cardiac condition, the baby needs more food but is
less able to do anything about it.  If I were following this baby I would
want to know that head circumference was increasing and I'd want to measure
length as well.  If the growth deficit is still asymmetrical it isn't as
much of a crisis as when brain growth, of which head circumference is an
indirect indicator, also slows down.

About the tandem nursing: it is probably the main thing protecting mother's
supply, and any health professional working with her should have that
spelled out for them, by you, Karen, if that is most appropriate.  Hooray
for that older sibling!

I'm confident that the baby will start acting happier when nutrient intake
matches needs.  It may not be possible to catch up by direct breastfeeding
alone, but after the gap between expected gain and actual gain is closed, it
might be that baby can maintain at breast alone.  But you won't know til you
get there, and it isn't going to happen without some alternative food
delivery method.  In our NICU they gavage feed babies at night if their
efforts at the breast during the time from 7 am to 11 pm have not kept them
'on schedule' for expected intake.  Might that be an option?

I have to say that if this were a baby **without** a cardiac condition who
came into my clinic, it would probably be admitted to the hospital on the
spot along with mother until it was gaining and catching up and we had some
clue as to why it hadn't been doing so before.

Rachel Myr
Not usually one to worry, and definitely not one to fix something that ain't
broke, but concerned now in 
Kristiansand, Norway

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