Jeanette,

Your case is a perfect example of when whatever milk the baby may be
recieving may need to be diluted.  I HATE  saying though that the "EBM
is too rich", what a negative message!  All milk is too rich at this
point for these already sick babies.  It is a problem with the baby,
not a quality of the milk.  It so frustrating when the baby who has
already had NEC (necretizing entero colitis) or in danger of it must be
limited in the amount or strength of BM s/he recieves.  NEC is one
condition that has a decreased incidence in a breastfed population but
sometimes baby just can't handle enteral (through the gut) feeding yet.


Some other techniques to advance feeding that I have seen used are:
1)limiting the volume of milk (in addition to dilution) and gradually
increasing of a period of days to weeks
    A) even using such tiny amounts as to be negliable as far as
       nutrition goes (like 1cc every 6 hours - like I think you said -
       to "prime" the gut
2) using continous gavage feeding as opposed to intermittent so a baby
might get (for example) 5 cc steadily over every hour instead of 15 cc
in a bolus every 3 hours   (this is an important reason to feed fresh,
refrigerated breastmilk as opposed to the stored, frozen breastmilk)
3) rectal stimulation with no suppository, just a lubricated
thermometer tip , and of course the suppositories if this doesn't work.

In regard to protecting the IV (intravenous catheter) because the baby
was a "hard stick" - it can be tough.  If you lose an IV you risk
having to do a surgical procedure to get in a new one.  Meanwhile, baby
can drop his/her glucose levels, get off important medication
schedules, etc - which can have devastating effects.  Some IVs are very
precarious, hanging in there by a wish and a promise only.

Kangaroo care may have to wait.  I love Kangaroo care but it isn't
always possible as early as we would like.

Hope this doesn't seem anti LC or anti BFing, I've been the RN in the
NICU and the LC in the NICU and seen both sides.

Carla (just north of Washington, DC)