I don't know if the weekend is making me crazy, but the last three cases I saw before leaving have me on pins and needles. Moms have my home phone number. One case in particular: Baby born at our hospital 36 wks with Hydrocephalus and sent immediately to our Pediatrics Hospital for surgery. Saw mom with baby in my office at 6 days old. Surgery completed, Mom has been taught to monitor the shunts and measure baby's head daily, reporting if there is no reduction or an increase in measurements. She had been pumping and bottle feeding fearing baby would be unable to breastfeed. He attached beautifully and nursed well, took over 1 1/2 oz. and dropped off relaxed. His mom (and all our nurses who had cared for him before he was transferred therefore stopped by to see him) was thrilled that the bottles had not created the dreaded Nipple Confusion. I was thrilled NOT to see another "tongue sucker". My instructions to this mom were similar to our other moms - nurse on cue, but wake baby if he has slept over 3 hours and offer breast. Watch positioning and swallowing carefully. Count wet diapers and stools, especially stools. She was to call me if she had any questions or had fewer than 2 profuse stool diapers in 24 hours. My concern is because of the shunt - my knowledge of how much fluid these remove from the head and how quickly is very limited. My question is: How much fluid is the shunt removing? Could it cause the number of wet diapers to increase without baby having received enough breastmilk? Watching I & O's (Intake and Output) can be decieving if the shunt is removing enough fluid to cause more wet diapers than the actual intake of breastmilk by baby. Thus I stressed the stools - but I wonder also if there is any other way to help monitor this baby? Why do these cases occur during Holiday Weekends? Jeanette Panchula, BSW, LLLL, IBCLC, RN Puerto Rico [log in to unmask]