protocol for assessing babies in

Donna Zitzelberger BSN, CLE posted a proposed hospital protocol for assessing babies in
hospital:
>First 24 hours of Life:  one urine and one stool (tarry black)
>Second 24 hours of Life:  3 urine and 3 stools (tarry black or green)
>Third 24 hours of Life:  3 urine and 3 stools (green)
>Fourth 24 hours of Life and after:  6-8 urines and 3 stools (may have up to 6-10) , stools
changing to green/yellow

I am interested in hearing input from the gastroenterologists and other specialists who can
better address this subject. My first reaction to the above protocol is apprehension. Do we need
to qualify and quantify this much?

Since I am not hospital based perhaps I do not have the same urgency for documentation. I see
infants after they are discharged. Stooling is my "gold standard"   :-D  for determining how feeds
are going so I always ask parents to keep track. Many of the infants I follow have no stools
between days 2 and 5.   An in-person evaluation is called for but, as long as the baby looks
healthy otherwise,  is nursing appropriately,  has passed stool at some point since birth, and is
making wet diapers I tend to "wait and see."  Day  5 seems a popular day for "action" by the
baby. In fact, IMO, Day 5 seems to be a day of action, in general, for babies. Perhaps it takes
this long for some babies to realize they are born? <g>

Starting babies on formula because (1) "milk is not in" or (2) because stooling is not going by
protocol seems ludicrous and counterproductive. Colostrum is milk, and its "in." Formula feeds
only get in the way of assessment and breastfeeding. How is "dehydration" or "low sugar" being
diagnosed? IMO most of the time it is very unscientific assessment that leads to the opinion
that baby is dry or hypoglycemic.

Of course I see the need to use stooling as an assessment; however, I worry that babies will be
subjected to inappropriate interventions based on unrealistic expectations. The older I get the
more concerned I become of having assessment "tools" transformed into dogma and protocols.
This seems to me to be leading further down the path of medicalization of breastfeeding.

Well, now I have found one of my hot buttons!

Stepping down and watching, with interest, for discussion.

Margery Wilson, IBCLC
Massachusetts Institute of Technology Medical Department
ILCA Region I (New England states) Representative