Been following all the comments on hypoglycemia in response to my post.   I
still am not convinced about the IV.  Please educate me (without the
insults -- I do NOT believe that ABM is equivalent to breastmilk and I am
NOT on the side of the formula manufacturers; in fact, I was instrumental
in developing an in-patient  lactation support program that is now a 7 day
a week service offered to our in-patients.  Unfortunately, we still have
the "reps", but our presence creates a watch dog.  Before we were there
seven days/week, the formula reps were like vermon.  In fact, one rep went
so far as to hold raffles.  Each time a nurse gave a gift pack of her
company's product, that nurse could drop a ticket in the can -- i.e. an
empty can of you know what.  This rep would then hold a monthly raffle,
giving away things like pasta dishes and espresso machines.  We got rid of
her raffles and her.).

Here's what I want/need  to know:

(1) Carol, I still feel that starting an IV should not be the first course
of action when a less invasive method can work.  I agree that human milk
from a milk bank would be the ideal solution.  I would absolutely like to
see access to a human milk bank happen at our facility.  I am in Southern
California and we do not have a local bank.  From what you said, it sounded
like access would be easy.  What am I missing?  How can I make it work at
our facility?   When a doctor prescribes human milk, how long does it take
to get the milk?  Can it be kept in-house like a blood bank works?  Could
it be kept by the blood bank personel?  What is the cost factor?  I would
appreciate any information that would point me in the right direction.  TIA

(2)  Nancy, I looked through the WHO reveiw of literature on hypoglycemia.
WHO states "Infants too immature to suckle should be given supplementary
feeds either by cup or by gavage. Breastmilk or formula is preferable to
dextrose water as it has greater energy density and contains fat which
promotes ketogenesis and reduces glucose oxidation".

This statement supports my stand on not feeding a hypoglycemic baby D10.
I am talking about the baby who is symptomatic, not suckling well at the
breast and would need a gavage feeding.  Sure the baby could also receive a
gavage feeding of pumped colostrum, but colostrum doesn't often express
well from the breast, the first hours after birth.  Please know that I
always have moms pump in this situation and use all breastmilk that is
pumped.  I must support everything I say and do with studies in order to
convince our neonatologists. I would appreciate any studies or hospital
policies you have about the D10 that indicate there is not a high/low
problem with this method of treatment.  TIA

(3) An additional problem with starting an IV on an infant is the cost
factor.  The acuity level of the baby goes up.  I know, I know, it's very
frustrating but it is a very real issue in the large HMO I work for.

Donor milk  seems to be the best solution.

Your thoughts/opinions are greatly appreciated.

Donna Zitzelberger, RN BSN IBCLC
who spends her work days in the trenches fighting one battle at a time

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