Wise Ones:
I have permission to post. I am attempting to assist a client w/now 2 week
old infant who was born at 32 weeks. Birth weight was 3 pounds/2 oz, and
baby weighed 3 pounds/11oz as of yesterday. Infant is still in NICU and is
being gavage fed formula. Infant is no longer on respiratory assist, and no
further complications other than weight. Mom was told to dump all colostrum
(!) because she was on Mag Sulfate for what she called 'a seizure' during
labor; (Mom had preeclampsia). (I am aware that Hale classifies Mag Sulfate
as L1.)
Mom has never been permitted to give breastmilk but has been pumping
consistently, and her supply is secure. Mom has not even been permitted to
use Kangaroo Care and is doing amazingly well in persevering in her desire
to BF this baby, despite being excluded from participating in baby's care
by medical staff.
I have searched the archives, but am unable to find the information I need.
Could someone please provide me with a 'formula' for calculating daily
intake by baby's weight? I seem to remember the figure 2.2 times pounds of
body weight equals oz. of 24 hr intake; is this correct? How would you
transfer a liquid measure, ie cc/ml to a weight measure like oz?
My intent was to provide Mom with a reference to take to the baby's MD, so
that she could ask to have some of her breastmilk added to the formula. MD
has informed Mom that baby is to receive only formula until weight comes up
to level where baby can be discharged.
Additionally, I know that the caloric content of breastmilk changes
throughout the day...is this taken into consideration when calculating 24
hour requirements?
Finally, would you suggest references to me for helping her transition to
breast from gavage feedings? Does Paula Meir cover this in any of her work?
I would appreciate any references you think would help. I anticipate a
significant amount of time before this baby is released and want to help
her prepare for her baby's homecoming.
Please, no flames. I realize that I am inexperienced in working w/preemies
and their needs, but this mother approached me for assistance. She was ER
C/S at a local hospital with no LC (in an area where I practice), and the
baby was air-lifted to a NICU more than 100 miles away. Considering that
the NICU does not have an LC and that she has not waivered in her desire to
BF this baby, (her first), I want to do all I can to empower her.
I will spend whatever time is necessary to read and absorb all references
any of you might suggest. This mother is low income and cannot afford to
pay for the services of the only other LC in my area, (who also has no
experience w/preemies). My services are free to her, as I work at WIC, and
this mother has no alternatives other than to go along with the MD and the
nutritionist, who are both suggesting that exclusive formula feeding is the
only way to go.
Can anyone arm me with volumes of references?
Niki Konchar, IBCLC, RLC (2005)
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