Thanks to Toby, Debi and Jan for more on this.
Debi, regarding the quantities of milk offered to the baby, I have a
fairly old South African book "The Newborn Baby", 2nd ed 1987 by 3
doctor/paeds, Harrison, Keet and Shore which "offers a practical approach
for those who plan to nurse or treat newborn babies" and give the info on p
76 " .. it is not necessary to offer more than 30 ml/kg on the first day.
Additional amounts can cause vomiting. The quantity is gradually increased
to 150ml/kg which is reached by the fourth or fifth day ..." My friendly
paediatrician tells me the amounts given to babies who are not breastfeeding
are 80ml/kg/day (Day 2), 100 ml/kg/day (Day 3), 120ml/kg/day (Day 4) which
brings us to 150ml/kg/day (Day 5). I don't know where he obtains these
figures, but it seems to be pretty standard. When working with FTT babies I
see that the paeds suggest even MORE, and my observation is that very hungry
FTT babies - when finally offered as much as they want - will take from 180
- 220 ml/kg/day, and of course regain lost weight very fast (up to 7Og/day
sometimes). Thus on Day 6 I would consider offering 180ml/kg to a baby who
is still passing brick-dust urine at this time.
I agree with you Debi about a hungry baby's need for calories, not empty
water. I query whether a hypernatraemic baby needs more strain on the
kidneys in the form of ABM - just a thought, comments from anyone?
Jan, the ONLY thing in print that I can find about the crystals is - same
book, page 328 - "A pink stain may appear in the diapers. This is caused by
urates which are present for several days. A mother needs reassurance that
this is not blood." That's it! Yes, indeed, WHY isn't it seen in all
babies who are dehydrated. On the other hand, why IS it a sign of kidney
failure in an adult?
I would really like to be dismissive of this. I would really like not to
worry about imminent dehydration, and to be reassured that it's all quite
normal. But it must mean something. What? More please anyone?
Pam, Zim
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