Thanks to all for your input on my broken clavicle patient.  Friday night I
was asked to come into the hospital to do a consult on an inpatient, and
when leaving I found another consultant seeing the baby with the broken
clavicle.  (I had talked with the baby's mother that morning and asked her
to come in before her pediatrician's appt and let me work with her, but she
hadn't shown up by the time I left in the afternoon.)

Mom's milk was in, baby was still being finger fed 4 days after delivery.
From the history I could get, the amounts being finger fed were
insufficient.

The baby would not nurse at breast, just shut down, even with starter SNS.
The baby closed her eyes and tried to participate as little as possible.  I
pumped the "teat" of the starter SNS for awhile and got some breastmilk
into her.  The other LC finally put the breastmilk in a bottle and the
baby's grandmother fed the baby, who drank 2 ounces while the mother
watched and pumped, with an expression of either great apathy or
exhaustion--difficult to read.  The grandmother said the parents had not
supplemented the baby with any formula due to "lack of money" (I had
recommended an expensive formula--Nutramigen--but I had given them a $5
coupon to bring the cost down to the price of regular formula).  They also
said they "couldn't" bring the baby in sooner because the husband had to
work.

Baby somewhat jaundiced (17) and sleepy; almost never cries.  I reiterated
(again) the importance of getting the baby fed, emphasizing that the mother
had plenty of breastmilk so pumping was a good solution if baby would not
nurse yet.  The other LC put them on a schedule, 2 oz pumped breastmilk
every 2 hours.  They have a pump on loan from WIC.

Nothing else to tell yet.  I have tried calling back for follow-up and left
a message on their machine.

[log in to unmask] (Arly Helm, LC)