Susan writes:
Now there is another infant in the same circumstances. This second infant
is 8 days old and has lost > 20% from birth weight. The pediatrician told
the parents that this it is normal for an infant to loose a lot of weight
in the first week of life and not to worry about it, just pump extra milk.
The mother is not able to pump enough milk to feed this infant even though
she's practically pumping around the clock.  My supervisors put in a call
to the pediatrician's office to let her know that the mother is unable to
pump enough milk for the infant, but have as yet received no return call.
I'm dreading the potential next news about this infant.

Gosh, Susan, this is a really scary situation. Is this baby being
supplemented? It doesn't sound like the pediatrician is even following up. I
think you have to take responsibility for making sure that an infant like
this has access to immediate medical attention before the family leaves your
center.  I'm not sure what kind of a setting you work in but in our hospital
based clinic we would first call the pediatrician and if we did not get a
satisfactory response the family would be sent to the ER.  We aso would try
to feed this baby by whatever means possible and if there was no breastmilk
we would use formula. I must say, though, we've never had a pedi not respond
to a  20% wt. loss.  This has to be accompanied by significant dehydration.
If you have continuing concerns about this pediatrician I would speak to
his/her colleagues in the community.  Your supervisor should help you with
this. Let us know what happens.

The last 20% wt. loss I saw was in a baby born at 5-1 and readmitted at 4-1
at one month of age. This baby came in with a dangerously low body
temperature. I fear this baby would have died at home if he hadn't seen the
pediatrician for the one month check. In horror she immediately admitted the
baby who quickly turned around with hydration and calories. This baby nursed
continuously all day long and parents thought she was doing ok. Mother was
only making about 2 oz. of milk/day.  Intense measures to increase her supply
at this point never made any difference. This baby had a strong, coordinated
suck even as she wasted away. The mom just didn't have any milk.

Kathy Boggs, RN, IBCLC

             ***********************************************
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