Jan:

I was really pleased that you brought up the subject of supplementation as
I have been working on newborn weight loss guidelines and was about to
post to Lactnet as I have not been able to find anything "definitive"
about supplementation amounts. The main reason we developed guidelines in
the first place is to assist community health nurses who are visiting
those babies who have been discharged home from the hospital and continue
to lose weight due to breastfeeding problems. These visits always seem to
happen on the weekend and the nurses find it helpful to have some
guidelines- when do we suggest supplementation, when do we worry about
hypernatremia, etc. The nurses are not usually lactation "experts" so it
does not help to say "Use your judgement". They need evidence based
strategies.

So....When a baby has lost over 10 percent of birth weight AND
breastfeeding is not going well AND there is no "expert" for the nurse to
consult, our guidelines recommend supplementation until the baby ( and
breastfeeding) can be assessed more thoroughly. After investigation , we
have found that some nurses have been using a formula (no pun intended)
of:     150 ml/kg x body weight (kg) x # of feeds per day (maintenance
amount)

Others use:             180 ml/kg x body weight (kg) x # of feeds per day
(catch up amount)

For a true failure to thrive (which the nurses do not encounter often) the
formula is:  200 ml/kg x wt.x # feeds per day.

So, instead of an answer, I have a question:  do either of these amounts
seem reasonable? How about giving the parents a range, say 150 to 180
ml/kg  (of course, working out the amount per feed for them)?

While I am on the subject of hypernatremia- how would the community health
nurses determine when a baby has lost so much weight that supplementation
may be harmful and the only course of action is to get the baby to an
emergency department asap?

Julie Whitman, RN BSN IBCLC
Lactation Consultant
W. Vancouver, B.C. Canada

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html