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Subject:
From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 22 Feb 2004 23:27:15 +0100
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Cindi Swisher posts about a baby she is concerned about, and rightfully so.
I had to convert the weights (8 lb 3 oz, 7 lb 8 oz, and 6 lb 12 oz) to
metric to really get a handle on the loss:
birthweight 3720 g, so 10 percent loss would put baby at about 3350 (3720
minus 372 - see how great metric is?).  Baby was within normal limits at day
four (3400 g), but may never have been really feeding well, so when
engorgement set in, it toppled things in the wrong direction.

Regardless, a weight of 3070, or 17% below birthweight at 9 days should
alarm ANY health professional who is at all familiar with newborns.  And
given the behavior shown by this baby, the mother ought to have been taken
seriously and seen immediately for a weight check!  Lucky for all of them
that the mother was savvy enough to contact Cindi, because she has likely
saved them from a tragic outcome at worst and at the very least, an ugly
lawsuit.

It sounds like the baby is so weakened by this excessive weight loss that it
needs to be actively fed, possibly by gavage for a day or two, until it
quickens up again and can do its share of maintaining mother's supply.
Finger feeding is probably worth a try too.  They may have to give small
amounts of milk many times a day during this time, rather than expecting
this little one to consume amounts typical of babies at 10 days, as her
stomach is probably not used to large volumes yet. Diligent pumping,
alternatively hand expression, should correct the supply problems, unless
mother's thyroid condition has had something to do with it.  I would suspect
inadequate stimulation from a weakened baby first, and if pumping/expressing
doesn't bring supply back, investigate the thyroid.  A scare like this would
affect any mother's milk ejection reflex; support and more support are in
order.

Meanwhile, feed baby whatever is available!  I've seen babies gain
dramatically even when their documentable intake has been about half what
the pediatrician 'ordered', when what they were getting was expressed milk
from their own mothers, so it may be that the mother has enough to carry
baby through this emergency, but she should be followed closely (i.e. daily
weigh-ins at the very least) and supported well for the next few days, until
baby starts to gain, and stools return.

It is incredible that an ER could give a baby who needed IV rehydration
therapy 'a clean bill of health'.  The regular pediatrician may want to
reconsider her/his backup system if the others on call are that unfamiliar
with the signs of starvation and dehydration in newborns.

Cindi seems to have done everything right so far, but as she has shown, that
isn't enough when the rest of the team, except the family, is asleep on the
field.  Scary.  We'll all be waiting to hear how long it takes to fix this
one!

Rachel Myr
Kristiansand, Norway

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