I have found in my experience as a NICU lactation consultant in the last
4 years that test weights are a critical component of my practice.
Judy's outstanding post on the benefits of test weights in the community
is heightened in the NICU setting. But does change bring a tremendous
amount of resistance at first? Of course! 
 
If it's a matter of justifying the cost of the scale to NICU leadership,
that can be solved simply. Just one baby who is proven, by test weights
of course, to breastfeed better than bottle feed, justifies the cost.
How? Length of stay. Saving one baby just one day off the total of days
required in NICU pays for the scale several times over. Once it was
presented that way to my boss, we had the scale the next week. (And it
wasn't my idea. I have a brilliant head nurse to thank for it!)
 
Convincing the staff to use it is another story. I would say it took
over one year of having the scale on the unit before the nurses bought
into it. And getting them to use it properly requires reinforcement.
Naked weights are the least accurate. Once that is understood, it is
easier to get buy in. Why? Because naked weights don't account for the
output that occurs often during breastfeeding. If I'm about to poop and
then I am weighed, it looks like I've lost weight when you weigh me
again naked. So we simplify things for the staff and teach about
disconnecting anything that can be disconnected, such as leads and pulse
ox and including nasal cannula O2 (roll up tubing under the baby for the
10 sec it takes for the weight) if the nurse agrees the baby can be off
for a second. We don't disconnect the IVs. Reconnect, feed. Then repeat
this after the feeding. 
 
I've been fooled too many times in the NICU to trust myself. NICU docs
are all about the numbers. Prove that you can prove intake and
breastfeeding can easily become the first PO feed in your unit. My docs
became much more comfortable with direct breastfeeding in the NICU with
preemies when we got the scale. I also heavily relied on the Paula
Meier, Diane Spatz literature on test weights. Huge institutions with
model breastfeeding practices like CHOP are all about test weighing. 
 
Rachel Cruz, RNC-NIC, IBCLC, RLC
NICU Lactation Consultant
 
 

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