I don't know if the weekend is making me crazy, but the last three cases I saw
before leaving have me on pins and needles.  Moms have my home phone number.

One case in particular:

Baby born at our hospital 36 wks with Hydrocephalus and sent immediately to our
Pediatrics Hospital for surgery.  Saw mom with baby in my office at 6 days old.
Surgery completed, Mom has been taught to monitor the shunts and measure baby's
head daily, reporting if there is no reduction or an increase in measurements.

She had been pumping and bottle feeding fearing baby would be unable to
breastfeed.  He attached beautifully and nursed well, took over 1 1/2 oz. and
dropped off relaxed.  His mom (and all our nurses who had cared for him before
he was transferred therefore stopped by to see him) was thrilled that the
bottles had not created the dreaded Nipple Confusion.  I was thrilled NOT to see
another "tongue sucker".

My instructions to this mom were similar to our other moms - nurse on cue, but
wake baby if he has slept over 3 hours and offer breast.  Watch positioning and
swallowing carefully.  Count wet diapers and stools, especially stools.  She was
to call me if she had any questions or had fewer than 2 profuse stool diapers in
24 hours.

My concern is because of the shunt - my knowledge of how much fluid these remove
from the head and how quickly is very limited. My question is: How much fluid is
the shunt removing?   Could it cause the number of wet diapers to increase
without baby having received enough breastmilk?   Watching I & O's (Intake and
Output) can be decieving if the shunt is removing enough fluid to cause more wet
diapers than the actual intake of breastmilk by baby.  Thus I stressed the
stools - but I wonder also if there is any other way to help monitor this baby?


Why do these cases occur during Holiday Weekends?

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico
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