Hi,

I'd like some input on this one, please.  I just saw a baby today 9 days
old, birth weight 9 lbs. 6 oz.  He had lost down to 8 lbs. 9oz. and now
is at 8 lbs. 14 oz.  However, his mother has been supplementing him with
1 1/2 ounces of EBM and 1 1/2 ounces of ABM every 3 hours.  This kid has
never nursed well, usually only 2 minutes before falling asleep.  Today
he did nurse for many minutes, but only elicited an MER once on the right
side.  While nursing on the left side, there were no swallows, and the
new M----- Scale  showed no intake of breast milk from that side,
although he had managed to get 20 cc from the right.  His mother stated
that he had seemed "jittery" at birth, but that his glucose levels were
40 for the first 24 hours.  At 36 hours, however, his glucose was 26 and
he was given ABM in the nursery.  He was kept in the hospital an
additional day for observation and again it dropped to 20 and he was
given ABM again.  His mother has hypertension and has been on Aldomet
throughout the pregnancy. (She lost 26 week preemies last year due to her
toxemia.)  She is still taking Aldomet, because her blood pressure is
usually high, although during this pregnancy it stayed low on the drug.
The baby also felt warm to me during the consult, so we checked his
temp.  It was 98.8 F axillary.  I got the mom started on an SNS so we can
try to improve his suck and give him the supplement while at the breast
instead of the bottle as she has been doing.  Mom states when he sucks,
she doesn't feel any "pulling", it's as if he's just mouthing the nipple.
Mom is going to check with the ped tomorrow about his temp.  Any ideas on
why he would have normal glucose the first 24 hours and then go
hypoglycemic?  Any thing else I can suggest to mom to get baby to suck
more effectively?  We're trying positioning, super switch, etc. At last
exam, the doctor felt the baby was a little hypotonic as well.
TIA

Kris Rogers, RN, BSN, IBCLC  Crystal Lake, Il