Sigh........I am going through many many resources for this one.  I am working with a mom whose little one is in the nicu for almost 6wks now.  BF was seeming to go quite well (this baby was on track to be d/c from the hospital exclusively BF - a record for 33+wkers at this particluar hospital!).  There is reflux going on - surprise! - but the apnea suspected to result is keeping the kiddo in hospital (one to 5 such spells/wk; desats, turning dusky, etc....).  Dr. has just recommended ceasing all breastfeeding and going to small bottle feeds (no plan to increasee frequency that I have heard of.....).  Mom comments that baby cries from hunger after feeding or that is her perception.  I do know the LC the mom has been working with in hospital and will have some discussion with her to make sure we are all on the same page.  Am trying to put together an email and just don't even know where to start - trying to remain completely evidence based but struggling a bit.  Several of the places I would normally go ABM and California Quality Control Toolkits (sorry if the name isn't quite right - you know what I mean) and being revised..... I have some good info but I guess I need some help to be articulate here as I am slightly dumbfounded by this whole thing.  Mom has been using a pillow! (ugg. babe compeletely sidelying) discussed positional feeds.  bottle feeds are fast, discussed position inc left side lying, slightly upright feeds and pacing for bottle feeds as well as nipple types.  Discussed kangarooing, elevated, left-sided and prone positioning for post feeds.  Discussed 'test' weighs, discussed possible need for non-nutritive sucking, discussed avoiding thichening feeds (haven't gone there yet - thank goodness!), discussed changing meds - currently on ranitidine.  Good properly documented info anyone??  Any docs or NICU staff out there who can help me? I've been on pubmed and going through texts for quite a while now....have info but want to use honey, not vinegar, to catch this fly.

Thanks so much (maybe this was a bit of a vent too...??)

beth

Beth McMillan BA IBCLC
Ottawa, On. Canada

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