I'm sorry, I do not have Paula Meier's e-mail address, but I can respond to
the question about checking for residuals after breastfeeding to determine
amount to top off the feeding.  Paula's practice has never been to conduct
this type of method for measuring volume of intake.  It is not indicative of
volume of intake physiologically.  Paula's research methodology consists of
performing pre- and post-feeding weights in gms using the BabyWeigh Scale.
This scale has been tested for its validity and reliability for its accuracy
in determining that 2 gms of weight gain equals 1 cc or ml of volume of milk
intake at the breast.  Paula also proposes that minimum fluid needs be
determined over a 24 hour period.  In other words, she states that if Baby
A's fluid needs are calculated to be 30 cc's every 3 hours, and pre/post
weights reflect 20 cc's for volume of milk intake at the breast, then Paula
realizes that most institutions would find the need to supplement the
remaining 10 cc's needed for that particular feeding.  However, Paula would
propose that the lack of milk intake be recorded and then perhaps the next
feeding would reflect a 40 cc milk intake, and therefore a natural pattern of
intake was secured.  This is of course in the perfect world. Paula also would
highly recommend that if possible, again in the perfect world, that the NG
tube be removed during the breastfeeding session as it may indeed block the
nares somewhat and thus interfere with the feeding session.  Furthermore,
Paula would say that checking residuals after a breastfeeding session is not
an absolute indicator of volume of intake because breastmilk is easily
digestible and therefore partial digestion may indeed have taken place and so
our amount of residual would not be a true indicator of intake.
Sorry this is so lengthy!  I worked with Paula on her research projects in
the mid '80's while obtaining my masters and I fully understand her projects
as a result.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
Geneva, Il

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