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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html