>I think I have posted alot about how and why and when I use pre/post 
>feed weights. Even though I don't routinely "test" weigh babies who 
>look good and are gaining, sometimes it is easy to put them back on 
>the scale (from their body weight check) and see what they've 
>consumed. I would say the range is 34 to 84 ml for 3 to  days old. 
>That's what I'm seeing.


What sort  of scale gives you that precision (34 ml, not 35 ml?), 
Laurie, and how confident are you? maybe you have different scales in 
the US, though.

>  Today was an Hispanic baby being breastfed but followed up with 2 
>to 4 oz of formula on every feed. He took 34 ml on one breast. Mom's 
>breasts were fuller but not real full, not surprising, she was not 
>bf much in hospital and supplementing excessively at home. The baby 
>had gained 0.5 oz in 2 days.


With this, you can wave goodbye to breastfeeding (unless there's a 
complete change of plan which will allow her to build up and maintain 
a supply) . I don't have to know the baby's weight or test weight. 
With  that sort of supplementing, she is not going to continue making 
milk. She has already stopped making milk.

>My advice - exclusive bf.

And it seems you agree!  I would be concerned to keep an eye on that 
baby and monitor output, even so, as it may not be possible to turn 
on the supply like a tap.  Reducation of supplements over a few days 
would be one option.

>Heather, I think it would be enlightening if you would share how you 
>would manage the following baby or advise and assist the mother:


Have to remind you all, I am not a clinician.  In the UK, actual 
clinical care of mothers and babies is done by midwives and/or health 
visitors.  NCT breastfeeding counsellors come in at the request of 
the mother. As I've said before, we don't weigh babies.  However, I 
am not exaggerating when I say our training and experience in 
supporting breastfeeding across the whole age range is considerably 
wider and more in depth than the standard education in bf of midwives 
or HVs, who do of course weigh babies.

>34 wk gestation, birthweight 5 lbs 15 oz, on IV fluids first day or 
>two, nothing by mouth. Began bf on day 2, very drowsy, spoonfed, mom 
>expressing for him. Baby had jaundice then and was on bili blanket 
>therapy. baby discharged on day 3 weighing 5 lbs 10 ounces. Dyad 
>comes for BF visit 48 hours later (now 5 days old), weight is 5 lbs 
>8 ounces. Jaundice has increased. Baby is breastfeeding exclusively 
>10 to 12 times per day. Mom has very good supply, extra in 
>freezer.Would you do something different if mother had very soft 
>breasts and not expressing much milk at all?


I wouldn't be doing anything here except supporting the mother - but 
I would be very aware because of my knowledge that breastfeeding is 
not going well for this mother and baby and I would not expect a baby 
of 34 weeks to be effectively feeding direct from the breast enough 
to meet all his needs.

**Most importantly**, in the UK, the baby would *definitely* not be 
discharged on day 3, and would probably still be in Special Care, 
and maybe for some time yet.  I would counsel the mother to seek 
specialist clinical breastfeeding help at the hospital. Places where 
there is good practice would encourage skin to skin and kangaroo care.

>(folks, you can manage this dyad without pre/post weights if you 
>have good followup). Also Heather, would you comment on what you 
>would advise if baby came back and had lost more weight (I'm 
>assuming you would do a body weight, would you or not?)


Well, I wouldn't, as I say, and the baby wouldn't be 'coming back' 
anywhere because he wouldn't have gone away in the first place!  No 
'follow up' , because he would not have been discharged.

I don't know enough about the day to day management of Special Care 
Baby Units, sorry, to know how often to expect a weighing. Intake 
would be monitored, and the baby would be weighed regularly, but I 
don't think I have heard of pre-term babies being test weighed.

Heather Welford Neil

NCT bfc, tutor, UK

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