Monique,

I will play "devil's advocate" a bit in this post. First, a 9 lb 1 oz baby
now on a ventilator and NG tube probably has several pieces of apparatus
including the vent, NG, EKG, O2 sat, and IV that is adding to his "actual"
body weight. Once these pieces of equipment are in place, it is a bit easier
to see the daily changes in his weight, rather than just looking at b.wt
compared to today's wt (6 day interval). What I am saying is perhaps baby
has not gained in several days.

Second, the diagnosis of resp. distress syndrome is unusual in a term baby.
(You stated the baby is term in the subject line and by his b.wt it would
seem he is. However, babies can be large - LGA - and still be premature,
particularly in diabetic mothers.) Perhaps his diagnosis is not the typical
RDS but something more is involved? Meconium aspiration? Early stages of
bronchopulmonary dysplasia? (6 days on the vent is a fairly long time).

His lung pathology will play a part in determining his fluid orders. The
docs may be trying to keep his fluid volume low until his lungs clear, or he
may have some heart involvement like a congestive heart failure type
situation. Does baby have any signs of fluid overload like enlarged heart,
peripheral edema?

18 ml per hour is 432 ml per 24 hrs and his requirements would normally be
about 675 to 712 ml per 24 hrs (I used 9 to 9.5 lbs to calculate). The usual
caloric standard is 20 cals/30 ml. So the additives can add 6 to 10 cals for
each 30 ml to his daily calories. However, we know that breastmilk is not
static and can have very high caloric content. I would advocate for the
hindmilk. You can "google" hindmilk or Paula Meier or Rush Mother's Milk
Club perhaps and get info for the doc on the use of hindmilk.

One thing I see ALL THE TIME and I let moms know it. Baby won't gain weight
and may lose a few oz each day until he is on FULL MILK FEEDS. That is to
say, as long as he is meeting his needs by some milk and some IVs, he will
lose weight. If the illness is short term and baby is getting well now, this
is not such a big deal. He will gain as he takes in the appropriate volume.
It is more a volume thing rather than the milk is not hi-cal enough.
However, if baby must go longer periods without being able to take in enough
milk volume, then he likely does need some added cals. Also, it is HIGHLY
LIKELY that baby will experience hyperbilirubinemia, if he has not already,
and will need phototherapy, and this factors into fluid needs.

The best advice I can give is for the parents to ask for a sit-down meeting
with the neo and have him/her explain the actual physiological problems,
expected course, etc. And then offer their wishes for total breastmilk diet
and see if they can work this out. Baby will likely need time and patience
and close f/u once he begins actual breastfeeding. Typically these babies
take time to settle down respiratory-wise. Good luck. I hope it works in
their favor and babe gets well soon.

<<Baby boy born 6 days ago, 9.1 oz at birth, now 10 lbs.  38 wks delivered
by
planned c-section....ng tube at rate of 18 ml per hour. Told baby needs
26-30 calories per oz of breastmilk.  >>


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

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