"I feel protocols for supplementing  been discussed before, but I couldn't
find it in the archives.  Does any hospital, especially an Australian one,
have a protocol for supplementing with formula.  A mum rang me Friday (late)
She has a 2wk old baby.  Mum had gestational diabetes.  Baby weighed 4100
grams (9lb?) at birth.  On discharge (day 8)weighed 3900g.  On day 13 was
weighed at home.  Had lost 10g.  Day 14 weighed in hospital, lost another
10g.  The paed (who shares his office with me, but not necessarily my
passion for breastfeeding) ordered 3 bottles of between 90-120ml of formula
per day.  The mum was devastated.  She actually thought she'd had quite a
good week.  Baby was sleepy and was feeding about every 4hrs, so I've told
her to feed more frequently and give each breast twice)  Mother was unable
to breastfeed her two year old as she was also prem and wouldn't latch
properly.  I haven't had the chance to assess a breastfeed yet.  Baby had
had no bowel motions for the last 2 days, but before that 2-3 per day, and
mustardy.  Any ideas, especially on how to approach the paed gratefully
appreciated
Barb
IBLC "
I can understand the paed beginning to get concerned that the baby is
continuing to lose weight at 14 days of age (not a lot but also not
beginning to gain).  Being an infant of a diabetic mother, were there any
issues with low blood sugar level in the early days?  The baby's early
history may contribute to the paeds concern.  Stooling patterns are
suggestive of decreased supply and/or intake.  It sounds like your primary
concern is the use of formula--which I can readily understand.  In my
experience if you suggest that the supplementation be in the form of breast
milk instead of formula the doctors usually readily agree.  Their main aim
is getting extra milk and calories into the baby (by whatever means) if they
are concerned about lack of weight gain.  Is it possible to get the mother
to express and supplement with supplemental nursing system,  cup or finger
feeding while working on supply, latch etc.  There are likely to be some
feeding issues if the baby is continuing to lose weight and hasn't stooled
for 2 days.  This would be preferable to giving bottles of formula
unnecessarily.

If this baby has already gone home protocols for supplementation in hospital
would not be relevant to a 2 week old baby at home.  If the baby was an
infant of a diabetic mother, who had low blood sugar levels, supplementation
with formula MAY be one option available for treatment while in hospital.
Ideally the first form of supplementation (if needed) is the mothers own
expressed milk after first trying a breast feed or donor breast milk
(however in Australia we don't have the luxury of that option). If blood
sugars are significantly low intravenous infusion of glucose is indicated.
The decision to supplement with formula is a contraversal one.  In my
opinion the mother should be given the option of IV gluose 10% infusion
before and instead of giving formula supplementaton. (of course I am talking
about unstable babies in hospital)  However some mothers are more distressed
with the potential seperation from their baby needed to be admitted to the
special care nursery for such intervention and in the early days some
infants of diabetic mothers do end up with formula supplementation to treat
low blood sugar levels.
Marian Rigney


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