Dianne,

It is so hard in 4th hand conversations to know what was really said and
what wasn't but on the face of things this seems to be odd advice.  You
wrote:  "Yesterday, the LC spun her milk down and told her it was low in fat
(26%) - and that she needs a 2500 diet to increase her milk fat content."

We know milk fat is influenced by time of day and time of sample within the
pumping.  Was this a random sampling?  If so validity must be questioned
just from that alone.

Lawrence (page)109; 5th edition says " The average fat content of pooled
24-hour samples has been reported from multiple sources to vary in mature
milk from 2.10% to 5.0%.... Maternal diet affects the constituents of the
lipids but not the total amount of fat".   Paula Meier says for most
extremely low birth weight infants a creamatocrit of at least 10% is needed
to "sustain a mean daily weight gain >15g/d" and that sometimes, <<for
smaller infants with especially high energy needs, we work with the mother
to produce hindmilk that is at least 12-13%>>  This was taken from the ABM
site http://www.bfmed.org/ where a sample newsletter is posted - ABM News
and Views Volume 4 Number 1 page 6.

The baby you mentioned is full term but you can't just double the fat
requirement. It is an increase in the volume of milk the infant takes that
also increases the calories and therefore the weight gain.  I don't know of
any resource that puts a percentage number to the crematocrit needed for a
full term but it just can't be 26%!  Also, you wrote the "baby girl is 4
weeks old, was 6# 2oz. at birth and is still 6# 2 oz. (she was down to 5# 8
oz. a week after birth).  She nurses well, swallowing is heard, lots of wet
diapers, and yellow, seedy stools."  So, while she is late getting back to
birth weight she has gained 10 oz.  Was this in the last 10 - 14 days or so?
She got off to a bad start, losing slightly more than 10% of her birth
weight. She could be doing just fine now.  She is peeing, pooping,
swallowing, and nursing well.  I think serial weights to determine what is
happening NOW are called for, and of course correcting any latch problems,
etc. if they were observed.  Crematocrits done poorly and misinterpreted are
not helpful.  Tell her to ask the LC for her references for 26% being low in
fat and for an increase in mom's calories having an effect on her milk fat
content.  If she really said these things and has no references get another
LC.

Carla (cranky again and home sick)

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