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Date: | Thu, 12 Apr 2007 18:40:23 -0400 |
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Hi Ann,
I'm a bit behind on posts, but we were just discussing this very issue this
morning in newborn nursery. The chief neonatologist was questioning why we
didn't let a bottle feeding baby take as much as he wants. He was a 3.5 kllo
3 day old who was hungry and with a big appetite. The nurse reiterated that
the clinical specialist was concerned about aspiration / overfeeding. And
that we were not supposed to routinely give more than 1 1/2 ounces to 2 at
most per feed to avoid regurgitation in the first day or two.. Some things
are just common sense and just can't be explained in a specific policy that
encompasses treatment for anything from a 4 - 11 pound baby.
We learned about the belly balls too and for the most part we do limit a
needed feed for hypoglycemia to 1/2 ounce if the baby is unable (unwilling)
to breast feed. That said 1/2 ounce is no longer approprate at 24 - 48 hours
of age for a 3-4 kilo baby. So where does physiology be replaced by the
scientific approach of 10-15 cc/kg of formula / iv /fluids / breast milk to
treat hypoglycemia which is the treatment that is outlined in our nursing
policy. There is absolutley no mention of the protein load and easy
digestibility of breastmilk as being superior to formula in anyone's
discussion of supplementation for hypoglycemia at our instituion, unless it
comes from the LC's.
As for breastfed babies and hypoglycemia - our big variance in practice is
how low is too low to go to the breast and then what is an acceptable after
feeding flexmeter glucose level. EBP says greater than 40 is normal, but our
lab defines hypoglycemia as < 50 and so newer nurses and older ones that are
not so breastfeeding friendly, are telling parents that a glucose of 50 is
low and requries supplementing. ARRRGH! Right now we are working hard at a
skin to skin initiative to keep hypothermic babies together to allow for
more uninteruppted breastfeeding. Let's hope that helps decrease the
incidence of true hypoglycemia a bit more. !
LuAnn Smith RN,BSN,IBCLC
York, PA
>>
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