Hi Val
With input from another maternity hospital, our paediatricians and very
supportive midwives we have come up with a flow chart to follow when a baby
doesn't feed.
Basically if they don't feed within 8 hours a full set of observations is
done (not BSL) and if obs OK can be left another 4 hours.  If baby doesn't
feed then (total 12 hours), another full set of obs, BSL and syringe feed
baby EBM (even 2 ml will do).  We have a BSL protocol if this is low, but
often as not if it is low before the EBM, 2 hours after the EBM it's fine.
The other issue that concerns me is the management of the lactation.  If
these mums are 'left' without expressing then you end up with dreadful
engorgement and all the problems that follow that.  So, I must admit, that
at the 8 hour mark I usually hand express the mother and give that to the
baby there and then - then I rarely get the low BSL at 12 hours.
Thereafter, if the baby won't feed I recommend hand expressing and syringe
feeding every 4 hours (though my suggestions aren't necessarily treated as
gospel).  We are very sensitive about the use of formula though and very
rarely resort to its use.  I've actually seen the paeds put in a glucose
drip rather than give formula to baby.  And I think that is a good response,
even though it is very invasive - afterall for a newborn not to be suckling
at 18 or 24 hours old, perhaps it is not a well baby.
Hope this helps

Denise Fisher
Brisbane, Australia

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