Dear Attie Sandink and Lactnetters, I apologize for the length of this and I
don’t presume that you don’t know this stuff;  my questions is…are all
section babies, even those who are asymptomatic,  being screened with a heel
stick and then “treated”  with formula?  Cutoff numbers for blood glucose
vary with the hospital, and the  AAP says "there has been no substantial
evidence-based progress in defining what constitutes clinically important
[neonatal hypoglycemia (NH)], particularly regarding how it relates to brain
injury, and that monitoring for, preventing, and treating NH remain largely
empirical." According to their guidelines, enunciated in 2011,   “infants at
highest risk for clinically significant NH are small for gestational age,
large for gestational age, born to mothers who have diabetes, or
late-preterm. Routine screening and monitoring of blood glucose is
recommended only for infants who have these risk factors or who have
clinical manifestations of NH such as jitteriness, cyanosis, seizures, an
apneic episode, tachypnea, weak or high-pitched cry, floppiness, or
lethargy, poor feeding, or eye-rolling.” 

 

There’s no mention of c-section. A sectioned mother has colostrum and the
right to have it collected before her newborn is given formula. And is
formula the necessary “solution” to a non-problem?   The ABM’s Protocol #1
says: “There is little  practical value in measuring or
treating…asymptomatic, normal term babies in the first 2hours after birth”.
The protocol goes on to say: “Studies have NOT (emphasis mine) shown that
treating transiently low blood sugar levels results in better short-or-long
term outcomes compared with no treatment”. And even the definition of LBS is
subject to debate. To continue with the ABM text: “Cornblath et al
summarized the problem: ‘Significant hypoglycemia is not and cannot be
applied universally to every patient” since “values are unique to each
individual”.  As I said, I’m sure that you are totally aware of this
best-evidence information.  Is there a chance you might use some of this
well-established info to influence policy if every sectioned baby is getting
formula?  if you see it as a possibility?

 

As for the gel, some of the information touting its ability to keep newborns
out of the NICU and keep mom/baby together is based on administering the gel
to  LGA or SGA babies   ACOG has defined an LGA baby as weighing above the
90th percentile and a SGA baby as below the 10th percentile. But many
hospitals will test every single asymptomatic lusty healthy baby weighing
over 8.5 lbs and under 6 lbs.  (And sometimes every baby in-between.) Are
all those babies  really LGA and SGA?  Should every mother whose “term” baby
is 8.5 lbs be worried  that her baby is hypoglycemic …without even the
consideration of possible weight inflation from IV fluids?   Suppose an
“SGA” 6-pounder is induced at 39  weeks.  Another week and she’d be over 6
lbs…the parameters do not closely mirror the real-life of birth and health.
So must every baby who fits those arbitrary parameters  be tested for LBS
with a painful and unnecessary heel stick,  and most often without prior
notification or permission from parents?  Is the gel really “saving” babies
from going to the NICU or are they just really treating a normal
physiologic state with a different protocol and congratulating themselves
that one unnecessary treatment replaces another?  As for testing every
sectioned baby, and treating with formula, can your talk include the
suggestion of the capture of colostrum from the breast of the mother?  On
day one, babies are physiologically meant only have the colostrum that
mother provides…no matter how much or how little that is.  The ABM protocol
goes on to say: “Even in those situations in which low blood glucose
concentrations do develop secondary to prolonged intervals (>8hours) between
breastfeedings, a marked ketogenic response occurs. The enhanced capability
of the neonatal brain to use ketone bodies provides glucose-sparing fuel to
the brain, protecting neurologic function”.

 

Again, I don’t presume that you’re not aware of all this info, and that you
need certain “recent hard data”  about the hugely varying sizes of the
newborn stomach on Day One… as varied as the size of the baby.    I also
know the power with which  hospital and staff  cling to established
protocols,  but  I hope you’ll have the opportunity to give the staff at
your talk some concrete reasons to stay away from routine care for every
sectioned baby. Again, apologies for the length of this possibly naïve rant.
Good luck!


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