Laurie
Thanks so much for referring Sandy to my handout - I see she's actually
from South Africa too!  Not that that's relevant, but she may not have
access to scales which she can hire out etc.  I composed an email to her
last night, attaching my piece on Low Gain, but my email program is playing
up so I didn't send it....This morning I've found another way, and already
sent it off.  I like the suggestions you made for getting more milk into
the baby, and I see that Sandy has already had several other Lactnetters
jump in with recommendations too.  Let's cross fingers..... Obviously this
pre-term little one never became competent at breastfeeding right from the
beginning..... Often I think we just expect breastfeeding to work like
magic, but if there are missing pieces to the puzzle it starts to fail,
simply having baby at breast does not always equal breastfeeding, sort of
thing..

Pamela

On Thu, Sep 17, 2015 at 2:46 AM, Laurie Wheeler <[log in to unmask]> wrote:

> By my calculations, baby had lost about 15% on day 5 and then made very
> very small gains with some interventions, which seemed well-intentioned,
> but ineffective. In addition, the time between weight checks is WAY too
> long. Pamela Morrison has shared a very EXCELLENT and thorough protocol for
> dealing with such infants, and I highly recommend you try to access it via
> the archives or contact [log in to unmask] for it. I am going
> to cc her this post, but I know she would not mind sharing, as she has
> shared it before, and would want to help you help this baby.
>
> If the mother herself is reluctant to use suggested interventions, this is
> a delicate problem, however she may not have been properly educated as to
> what is going on, or perhaps she is having some mental health issues
> including postpartum depression. Sometimes child protective services must
> get involved, but rarely.
>
> If I were working with such a case, of course I would be in touch very
> closely with the primary healthcare provider, and I would be having the
> baby weighed ideally every day or two until a turnaround occurs, which I
> would expect immediately. I would be very clear but not mean to the mother,
> in telling her very directly that her baby needs much more food for his
> brain and all his organs to grow and function properly, and that we must
> assess whether these sufficient calories do put the weight on, and if not,
> the hcp must urgently look for serious diseases. This generally gets the
> mother's attention and she will come along with the plan. Your counseling
> skills will come into play to explore her thought processes, possible
> misconceptions, etc.
>
> General protocol:
> 1. Feed baby by easiest method, probably bottle. I don't think I would
> have the baby even breastfeeding at this critical juncture, just get
> sufficient calories in.
> 2. Use all mother's ebm and next best alternate (this could be donor milk
> or formula) to make up the difference in baby's needs.
> 3. This means mother is spending her energy ensuring baby is taking in
> calories by easiest route and she is expressing to produce a full supply
> and/or preserve it
> 4. IF SUFFICIENT CALORIES/VOLUME ARE BEING CONSUMED (this can be
> calculated easily) and the baby STILL DOES NOT GAIN WEIGHT then the hcp
> should be looking elsewhere for reasons, often cardiac, sepsis, metabolic
> disease. This is usually not the case, but that instead the infant has just
> not been taking in sufficient volume=calories, but one does find disease
> sometimes. The baby is a preterm, after a difficult pregnancy, and then
> C-section birth, so there are some risk factors here.
>
> Do keep us posted if you can,
> Laurie Wheeler RN MN IBCLC
> Louisiana and Mississippi, USA
>

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