To all you great supportive ones (great-ones);
I will start out by thanking all of you who have the energy and find the
time to be so supportive and provide so much info. to peoples questions. I
can't seem to do this. We now have lactnet constantly on in our clinic and I
can follow a general thread. I would like to answer some of the general
problems but can only seem to deal with my own "in hospital" practise,
living from crisis to crisis. (I'll send another message about crisis)

In December I sent an exciting report to you about progress made towards the
problems of hypoglycemia, however now new problems arise every day.
Protocols in place are interpreted differently by every nurse. Giving them
the option of Nutramagen rather than using cow or soy milk based supplements
has blown into an all out supplementation craze. We haven't changed the
"protocol" to supplement when medically indicated only.

These difficulties are however being worked on and an all out battle has not
yet broken out. The Peads are still pretty positive although I'm starting to
doubt myself. How do others feel about using a supplement (vegetable based
etc.) as option 4. { 1. direct breastfeeding, 2. mother's own expressed
milk, 3. donor breast milk, 5. cows milk based and 6. soy based and the last
4 only if the first three options are not available?

Several comments have been made by some of the peads. Nutramagen has not
been proven long enough, as a formula andis much too expensive. if we use
this even on a temporary basis, and in hospital the mothers will think this
is what they need to use.

While reading the fine print in our "hypoglycemia" protocol, we realized
that Blood sugars need to be done for babies of all mothers who had
Pregnancy Induced Hypertension, are on Beta Blockers or have been on
Ritadrine. Blood Sugars in our hospital are done first with a bedside type
of Glucometer and if values are below 2.5 (Canadian) they will be done by
the lab. However generally nurses do not wait until the lab results are back
before they supplement. And of course they have informed (or frightened) the
mother that this should be done in a hurry. There is often a great
discrepency between glucometer and Laboratory values. Etc. Etc. ( Teresa P.
your grandson's story came to mind. I always question the use of oral
supplement in a medically unstable infant, or wasn't the respiration rate up
yet when the first low blood sugar was taken) Heel pricks in infants are
done much too frequently in my humble opinion.

Another pediatrition really wants to know where I got my information about
gut closure as being so important before giving anything other than breast
milk to the infant. He said he looked everywhere, even on the Net (he
doesn't usually like to use the computer). I wonder which data or research
would be the most convencing. Evidence based practice is starting to
infiltrate our hospital but I'm conviced a little goes a long way while a
lot just turns them off.

Hope I haven't overwhelmed you folks?

Attie Sandink RN. IBCLC. Burlington, Ontario

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