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From:
"Johnson, Martha (Lactation-SHMC)" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 18 Feb 2001 12:55:33 -0800
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Why does the ped want baby to have an ounce?  Most 4 hr old babies are just
fine with the few drops or few ccs that the average mom makes.  At our
facility, we give the baby a full 24 hrs to learn to breastfeed, check the
blood sugar if they haven't latched by 8hrs, and don't consider
supplementation until the 24 hour mark, unless baby has a blood sugar <36,
or has dropped >10% of birthweight.
  These docs need to consider that if this baby had been offered a lower
volume that was closer to the physiologic amount available from mom, risk of
aspiration would likely be reduced.  Also by jumping to supplement in just 4
hrs, they are increasing baby's risk for IDDM and allergies, as well as
changing the gut flora for weeks to come.
BTW, great job with boosting your initiation rates!
Martha Johnson RN IBCLC
Eugene, Oregon

-----Original Message-----
From: Cathy Morris, BSN, IBCLC [mailto:[log in to unmask]]
Sent: Friday, February 16, 2001 10:44 PM
Subject: need help: finger feeding and aspiration


My first post. Hello everyone.
I didn't see this baby but I promised the staff to look for information:
Today a
term newborn who was being finger fed (apparently by a nurse) due to failure
to latch on well
in the 4 hour time period our hospital's pediatricians require was
tranferred to the Level III NICU an hour away (we're pretty rural here)and
given a diagnosis there of "aspiration due to finger feeding." I don't
yet know what was in the tube. (This was a 5 p.m. Friday phenomenon, so some
of my details are sketchy.)The
baby is having respiratory distress, the parents are understandably upset
about their baby, I'm sure the nurse is very concerned, and the pediatrician
involved has changed his standing orders - none of "his" babies can be
finger fed (bottles or breastfeeding only)for any reason at any time by
anybody during hospitalization. One of his partners has also changed his
orders and the other two are discussing changing theirs. Since they see most
of our new babies and are very strict about blood glucose testing and early
supplementation in "breastfed" babies, we will not have an option for
interim feeding/enticing to the breast.

We're a community-based breastfeeding program that provides lactation
specialists and consultants to the hospital for daily rounds free of charge
and we do staff continuing ed for the hospital.

Our planned response is:
1- Get a nurse/physician team (preferably) in here ASAP for careful
inservice of every single nurse and physician on safe finger-feeding/cup
feeding techniques - should be a review, but for some who avoid inservices
it may be new material.

Any recommendations on folks to try to get to come in? We need several ideas
because scheduling is always a challenge if you have short notice (our
breastfeeding rates will probably take a nosedive even as I write this,
although we are going to push the OBs and L&D nurses to put the babies on
the mothers' bellies immediately and encourage the breast crawl- they are
pretty sporadic with that approach now, so wish us luck- to do primary
prevention of low blood glucose and use of bottles of formula or D5W).

2- Provide the docs with any information available on relative risks of
aspiration with
bottles, cup feeding, or finger feeding. I can tell from LactNet archives
there isn't much out there.

Anyone have any references? Has anyone done the studies yet? Does anyone
know the specifics on the articles
by Paula Meier on aspiration with bottle feeding?
Yep we know formula and D5W are worse than colostum, but the doc wants an
ounce or so, and my experience is that 4 hour post delivery moms can't pump
that. (Yes, I've seen a couple of exceptions, too.)

3- Any information on returning to the breast after resolution of the
respiratory distress in these babies? The parents may want to know what
their options are.

Many thanks for any help. We see this policy change as an emergency, so
we're going to
move as fast as we can. Our babies have gone from 12% breastfed at least
once to 44% breastfed at least once with our program in an area where
(obviously) no one thought much of breastfeeding. We've been tackling the
duration issue with some success. Now this. We can't let it slide back.

Cathy Morris,BA,BSN,RN,IBCLC
Training Coordinator
Heart of Georgia Healthy Start

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