Karen,
Baby is 6 wks old and has lost 8 oz - I would consider this a medical
emergency. The first thing I would do would be to be very very generous with
the feedings. On babies that are losing, I find, once the supplement is
liberalized, they gain 4 or 5 oz in a day or two. If mother prefers donor
milk, she can use from her source or try to obtain from a milk bank (dr
could order it). I would not think it was retained placenta if milk came in
on day 5 (how fully did it come in - most moms are quite full). The risk
factors are the 35 wks gestation and I suspect baby was sub-optimally
draining the breasts. The high bili of 17 indicates starvation jaundice,
unless there was some pathology like blood type incompatibility, bruising,
etc. It would not be a mommy problem if she had lactogenesis II in my
opinion. the supply would be low now due to the baby not milking the breasts
well and I'm guessing mom did not start out expressing extra for him.
If liberalizing the feeds doesn't work immediately in 24-48 hrs, then the
baby needs to be worked up. Maybe cardiac, sepsis, metabolic, or some
developmental delay. Any oral anatomical variations? The mother should
kangaroo care and feed the baby whenever he peeps, any stirring or rooting
whatsoever. I would try to feed him every hour or two. I calculate he needs
15 oz per 24 hrs or more. Is he taking that? Does he have any trouble taking
the milk. Use the supply line at breast if he has a good latch and suction,
if not, use a bottle would be my recommendation at this point.
As far as the organic formula, is it homemade? What is the calorie count of
it.?
Karen, I don't know when you began helping this mom, but I'm saying this
next bit for the benefit of anyone to the arena of breastfeeding work: do
not let this lack of wt gain go for more than a few days. If baby is not
gaining by day 4 or 5, I get very worried and start interventions. Then f/u
in 24 - 48 hrs. Hope this baby turns around soon.
Laurie Wheeler RN MN IBCLC RLC
new orleans louisiana USA

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