Dear Joy - I found your post of Wed, 5 May 2010 10:28:22 -0400 to be
extremely important.  If anyone missed it, you may want to go to the
ARCHIVES and read it in its entirety.  The following are the parts that
struck me the most:

 

- The opportunity is there for fetuses to pick up fluid (passive diffusion -
electrolytes [and therefore fluid] move from an area of high concentration
to areas of low concentration).

- Maternity nurses who had worked other areas (eg, dialysis, cardiac)
questioned the cavalier use of fluids - patients in other areas would likely
have experienced pulmonary edema or heart failure due to the overuse of
fluid.

- I want to see if I can pick up an association between the maternal IV
fluids and neonatal weight loss.

- Battaglia et al (1960) were probably the first to show that maternal IV
fluids affect the neonate [1960?  Many of the anesthesiologists of the 70s,
80s,.to the present have denied this as a possibility.]..Others also showed
the relationship, as did Dahlenburg et al - cord blood was hyponatremic (low
sodium - in other words diluted).  

- To say 7% [weight loss in a neonate] is a problem is to say half of the
babies are compromised..The nadir (lowest point) is around day 3 and with so
few measurements, how can one assume the lowest weight was even measured.

- Assuming a normal curve, the 7% with SD of 2 suggests 95% of babies will
fall between 3 and 11%.  The biggest problem with my systematic review is
that it does not relate weight loss to morbidity and mortality - essentially
it shows a pattern but does not answer the so what...

- The other thing I came to realize is that we assume birth weight (the
first weight within minutes of birth) should be baseline.  Why?  In
dialysis, there is something called "dry weight" (I cannot find it in any
other area), and dry weight is the goal weight (weight without extra fluid)
for each dialysis.  What if the theory is right and babies are over in their
fluids?  The weight loss is a correction - getting back to dry weight.
Baseline should not be the first weight.  Baseline should be following
diuresis.  In other words, there is an assumption that all weight loss is
due to lack of food, and everyone has set this false baseline as the goal to
get back to.

- At this point, there is no CLEAR [Lee's emphasis] evidence of an
association between neonatal weight loss and maternal IV fluids, but we are
closer to showing that there are non feeding factors related to weight loss
and that there may be weight loss that is a correction [and] not cause for
concern.

 

Joy - ALL of your post will be saved.  May I have your permission to share
it with Midwives, OBs, Pediatricians, maternity RNs, LLL leaders and
participants, other moms who seek my help, etc?  Some of the points you made
reminded me of babies I worked with years ago.  There is one who I think of
often:  The baby had low sodium levels and the pediatrician told the mom
that her milk was to blame.  UGH!!!!!!  Yes, she was induced, had an
epidural, and wound up with a C-section.

I am not a medical professional but I wonder if hyponatremic cord blood
would affect stem cell research.and if the specialists investigated if that
affects umbilical cord stem cell transplants?

 

Also, I am not familiar with:  They all get "vapours"; please explain what
it means in your post.

 

Last but not least, I would like to include your credentials after your name
(to impress others) and where you are from.  Please forward them to us.
Thanks and keep up this important work!  Other than LACTNETTERs, there are
few who would realize the need for this type of research or how to conduct
it properly.  KUDOs to you!

 

Warm regards,

Lee Galasso, MS, LLLL, IBCLC, RLC

Westchester County in NYS, USA

"Children Are Born with the Need to Breastfeed"


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