Jennifer
Welcome to lactnet. There are several things that need to be looked at in 
this case, before deciding if or if not supplementation would be needed. But 
a decision has to be arrived at ASAP. The way I do it, first choice for 
supplementation, if needed, would be mother's own expressed milk. 2nd 
choice, donor milk if available, 3rd choice infant formula. (It goes without 
saying, that if direct BF can be easily fixed and/or more frequent feeding, 
then do that). I predict in this case, more frequent feeding will not work 
as quickly as needs to be.
You must establish if mother has enough available milk. This baby needs 
about 17+ ounces of milk per day at this point. If mother has plenty milk, 
then is baby getting it out? If milk is there in the necessary volumes, 
mother can pump and alternate feed til baby improves. If baby is not 
*effectively* transferring the available milk, then more frequent or longer 
feedings won't really help. If milk is not in adequate volumes, then a 
substitute milk must be used to make up the difference.
While underlying baby metabolic issue is certainly possible, it is not 
likely and *usually* baby is taking in less than adequate volumes in these 
cases. This can be a baby problem (premature, tongue-tie, etc) or a mommy 
issue (milk never came in, etc) or a combination - very common.
It sounds like the baby may be being worked up for reflux.
This is a very fragile baby and needs help right away. This will be a great 
case for you to expand your knowledge base, because often there are many 
factors contributing to the poor outcome that need to be investigated. Also, 
baby will need close and frequent followup til out of the woods. Do you work 
under a lactation specialist, like in the WIC program? I would get her 
involved right away.
Let us know how this mom/baby are doing.

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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