In answer to Wendi's question about what number we use as a "problem" number
for referral - we don't.  We assume that getting a VLBW baby (or any baby
who has been on ventilator support for that matter) will probably require a
lot of support, time and patience to breastfeed well, and assume the scores
will start out low and slowly progress. We just see everybody once or twice
a week, and have a system to make sure this happens.

The mothers love it when the scores start improving, and gavage
supplementation goes down.  A big day is when we start doing "on request"
feeds using our protocol to see if the baby is capable of waking and
"asking" to be fed, if he is satisfied afterward, and if he continues to
gain weight.

If the nurse or mother needs one of us more often, they leave a message on
our phone mail.  We also have the option of having our neonatal occupational
therapist help and she is a genius at getting premies to suck.

In the mother/baby unit, however, the number used for referral is 6 or
lower )excluding  the initial LATCH score in delivery)

Sincerely,
Deanne, R.N. IBCLC
NICU

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