Hi Dr. Jen,
There are so many factors in this case, it might take a while to get mom's
supply up and running.
In the immediate short term, I would be feeding this baby by alternate
method. I probably would not use a supplementer at this point unless I was
sure the baby was feeding vigorously at every feeding. He doesn't sound like
he's taking in much milk yet.
Based on his weight, the baby actually needs about 45-50 mls every 2 hrs, by
my calculations, so I  would be wanting to feed him 30 mls every 2 or 2.5
hrs, at least, hoping to increase over the next 48 hrs. Of course, mother's
own expressed milk is our first choice, then donor milk, then formula.
Spoon, cup, syringe, finger, or paced bottle feeding could be used. When
baby is more vigourous, the supplementer would be a good choice.
As much skin to skin as possible, having mother express 8-10x per day, becoz
I don't think baby is doing his job yet with milk removal. I would recommend
a hospital grade pump for mom.
I do think metformin would be helpful becoz it does sound like mom's insulin
and glucose are still not normal. If mother is very edematous, sometimes one
dose of a diuretic can help. I think it will take time and lots of support
for this dyad, perhaps 3-4 weeks, to get bf fully established. It goes
without saying, they need continued close follow-up. I wish them well.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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