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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