> I am writing for a friend who is currently with her 6 day old in hospital.
>
> Baby boy born 6 days ago, 9.1 oz at birth, now 10 lbs.  38 wks delivered by planned c-section.  Mother's fifth child (all previous by section, all previous breastfed long-term).   Diagnosed with Respiratory Distress and put on ventilator.  Doing better, tapering oxygen.  Given breastmilk through ng tube at rate of 18 ml per hour.  History of severe family allergies.  Mother is being told that baby needs more milk per day to meet his caloric needs but they will not give him more breastmilk volume for fear that his lungs will become wet. ..
> Baby has many wet diapers and had produced 3 bms today.


Even assuming this baby has some edema and current energy requirements are greater due to illness, weight and outputs appear to be OK for birth weight at 6 days PP. What evidence is the staff providing that the baby's caloric needs are currently insufficient? What evidence have they provided that they understand any differences that may be in place for BF newborn vs. formula-fed newborn?


> Told baby needs 26-30 calories per oz of breastmilk.  Mother is being asked to accept adding one scoop of similac per feeding, or addition of 1 tablespoon canola oil per feeding, or the addition of "elemental formula" to breastmilk.  Hospital does not have an LC on staff.
>


What research evidence have the docs/staff produced to support their contention that what they are suggesting is safe for a baby who appears to be doing well when considering the circumstances and is at risk for allergy based on "severe" family history?

Why do we BF-related health professionals or babies' mothers always feel it is up to us to come up with the evidence? When ANY health professional makes a recommendation, she/he should be able to support that rec with more than anecdotal, professional "feelings" or "we've always done it this way" info. Without infant outcome evidence indicating a need for a change in diet/additional calories, the onus re: evidence should be on the staff who recommended the extra calories.


> Mother does not wish to supplement and feels her milk supply is adequate and that this pace of feeding is perhaps excessive.   She would like to cull hindmilk and add to her own milk as a 'supplement' but hospital is unsure of this idea.
>

"Not sure" of hindmilk feeding but they are "sure" of their other recommendations re: formula or canola oil? Based on what research evidence? From what I can gather (or not!) from lit searches, there is a lot of experimenting going on with these kinds of recommendations lately...and very little evidence that they are safe or particularly effective. On one list for speech pathologists, concern for this "calorie-loading"/"bulking" via "thickening" by adding to "regular" human milk (or formula) was expressed re: potential implications on infant hydration. However, can't find related "safety" research!

And the staff is "unsure" about even trying some hindmilk feedings based on what evidence? When it comes to safe for a baby with high potential for allergy, I'd think hindmilk feeding would be worth a try (assuming additional calories truly are needed for this particular newborn).

Hopefully, someone in the mother's area will get in touch. In the meantime, I'm glad this mother seems to be advocating well for her baby thus far. I'd suggest she become a broken record in requesting staff to provide research or specific infant outcome evidence to support their recommendations about changing this particular newborn's 100% human milk diet. I'd also suggest she place a sign on baby's crib reminding staff of allergy history and No Formula or other dietary supplements to her own milk without expressed written consent of parents.

Karen

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