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Subject:
From:
Bobbie Middlemiss <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 25 Jan 1999 10:54:49 -0500
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In case there has been prior discussion re the management of feeding a
small for gestational age infant, I searched archives but did not find the
answers I was seeking.

We had a male infant, 2240 grams born at approximately 1:00 A.M. Thurs, Jan
21. Full term, low forceps delivery. The doc ordered breastfeeding q3h with
a supplement of 24 cal formula after every feed.

Delivery day: The babe made great attempts to nurse but tired easily, and
cup feeds of ~30cc of 24 cal formula post every feed, mom pumping. Voids &
mecs
Second day: perking up and starting to nurse more eagerly, every 3 hours
(messed up by the length of time especially at night that it took to get to
the supplement, babe in nursery, supps depended on nurses time). Mom was
double pumping after feeds and  I instructed her on cup feeding so that the
babe would get the supp right after its feed and suggested that the breast
milk was better than the 24 cal formula and that she give the breast milk
first and if the babe would take more, then go to the formula. This night
kept babe in her room 24 hrs. ++voids & changing stools
Day three: was pumping 2 and a half oz. , but about 15cc of supp was all it
would take. The babe was nursing, swallowing, having 5 voids and 4 yellow
stools in the 12 hours I was on duty, and yesterday recieving only breast
milk supps, almost forcing the issue because supps had been ordered.

As of yesterday morning, babe continuing to lose (but still only 3rd day),
and weighed 2100 gms (6.5% loss). The family physician was off for the
weekend, the doctor covering was happy with the way things were going and
would have sent this babe home Sun. knowing that an appointment had been
set up to see a ped on Tues. But, due to specific instructions from the
family doc that the babe not go "until he is gaining" would not discharge
the infant. Family doc refused to send babe home when contacted by phone.

Today, Mon. (into 5th day), the family physician discharged the babe, there
had been a 10 gm gain since yesterday (nurses kept babe in nursery and
cupped formula + EBM all night), but, the doc was extremely upset that the
babe had not continued to recieve 24 cal formula supps post every feed and
that we had given breast milk instead.

I found a reference in Ruth Lawrence's "Breasfeeding" (p.362) that gave the
results of a study that showed that forcing extra fluids may actually cause
an increased loss of weight and a more delayed gain. Makes sense, all that
fluid might suppress the ADH and cause excess fluid loss!!!

I would appreciate any current references re the management of SGA infants
who nurse well, void and stool appropriately, wake for feeds, not
jaundiced, (i.e., very normal for a full term infant) but not yet gaining
on the third day.

I would like to have an evidence based discussion with the family doc. He
upset the family in several ways: 1) did his visits from the doorway Thurs
and Fri without really examining the babe for himself. The parents didn't
think that he had really seen how well the babe was doing and was not
willing to come in or listen to those who had been with this family for
days. 2) was treating the babe as a prem, not a small full term babe, 3)
led the parents to believe that there is something wrong with this babe
that he was not telling them.

Any suggestions?

Thanks, Bobbie:-(

****************************************

Bobbie Middlemiss RN, BScN, IBCLC
e-mail: [log in to unmask]

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