Dear Laurie-

Thank you so much for your detailed reply to my posting.  Your intuition and
experience is right-on.

< <What I am saying is perhaps baby has not gained in several days.>>

Baby was given dieuretics for excess fluids and as of today weighed 8 lbs 12
oz.

<< Second, the diagnosis of resp. distress syndrome is unusual in a term
baby.
(You stated the baby is term in the subject line and by his b.wt it would
seem he is. However, babies can be large - LGA - and still be premature,
particularly in diabetic mothers.) Perhaps his diagnosis is not the typical
RDS but something more is involved? Meconium aspiration? Early stages of
bronchopulmonary dysplasia? (6 days on the vent is a fairly long time).>>

His diagnosis changed with changing doctors and changing hospitals.  He is
now thought to have had pneumonia at birth.  He was delivered at 38 weeks.

< <His lung pathology will play a part in determining his fluid orders. The
docs may be trying to keep his fluid volume low until his lungs clear>>

This is exactly correct.  Now that the dieuretics have finished, they are
allowing increased milk volume.

< <18 ml per hour is 432 ml per 24 hrs and his requirements would normally
be
about 675 to 712 ml per 24 hrs (I used 9 to 9.5 lbs to calculate). The usual
caloric standard is 20 cals/30 ml. So the additives can add 6 to 10 cals for
each 30 ml to his daily calories. However, we know that breastmilk is not
static. You can "google" hindmilk or Paula Meier or Rush Mother's Milk
Club perhaps and get info for the doc on the use of hindmilk.>>

Thank you for this.  A sample of mother's milk was tested in hospital was
came in at 25 cals/30 ml.  Adding her own hindmilk to this would seem to
bring her up well within the doctors' request for caloric increase, without
using artificial supplements.  (I would think?)  Tomorrow mother is being
asked to produce 24 oz milk for 1 oz feedings every 1 hour round the clock.
I am not sure if this is in addition to at-the-breast feedings or for
in-between breast feedings.  Feeding at the breast was being attempted this
evening, I do not know how that went yet.  There is some trauma to the
baby's mouth from the tube but it has been removed.  He is still getting O2
in low amounts and is finishing a round of antibiotics tomorrow.  If he
continues to improve he will be out of NICU in 24hrs and on a regular floor.
  He still has the ng tube "just in case" which I imagine will be a
distraction to first breastfeeding but hopefully that will be removed soon
as well.

> > Also, it is HIGHLY  LIKELY that baby will experience hyperbilirubinemia,
>if he has not already,
and will need phototherapy, and this factors into fluid needs.>>

Spot on, he now has delayed onset jaundice but so far bili levels not high
enough to indicate use of lights.

> > Good luck. I hope it works in their favor and babe gets well soon.>>

Thank you! This mom is such a strong advocate for her babies (and for
breastfeeding) that I know once this medical crisis has past she won't have
any trouble with the patience and dedication needed to get to full
at-the-breast feeding.  The information and support she has received has
been invaluable.

Monique

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