Marie D. wrote,in response to Susan:
"I just wanted to mention that seeing such a high weight loss amount
somewhat
> frequently makes me wonder if these babies had *true* birthweights. By
> that I
> mean was the birth weight artificially inflated. Did the mother have lots
> of
> IV fluids in labor, was she diabetic, did she have edema? All of those
> factors can cause inflated birthweights.
> A baby with 20% weight loss would be lethargic, have very few, if any
> stools,
> and generally look unwell.
> If these babies look OK and are still having lots of stools then I would
> suspect inflation or errors in the initial birthweights. We found that
> excessive maternal IV fluids and general edema in labor would make the
> babies
> weigh more at birth. Then baby would pee it all off and some would drop
> 10%
> or more. But they always looked great."
>
I saw 3 babies within 2 weeks who had 20% weight loss. No matter
what markers and definitions we use to determine "birth weight", a 20 % loss
is NEVER normal!!!! I don't believe IV fluids, edema, etc. could account for
enough weight difference to deem the subsequent weight loss okay. Seeing
those babies scared the you-know-what out of me and taught me some key
things. First, that it is supremely important what we teach these new Moms
for the short time they are in our care. (I am a hospital based IBCLC, and
previous NICU RN.) Second, that I needed to hone my telephone triage skills.
For example, when I asked one Mom if the baby was having wet
diapers, she replied, "Yes, several." And also stated the baby was nursing
about every 1 1/2 to 2 hours. Since she sounded so calm, I didn't question
her further. I came in the next day to find the baby readmitted to the NICU!
This baby was still alert, looking at us with his big eyes, his skin all
saggy. He had lost 2 pounds!! His electrolytes were totally out of whack and
his sodium level was over 170, dangerously high. His "wet" diapers were only
a trace wet. (This new Mom had no previous experience with diapers and
babies to compare this to. And evidently our teaching had not made it clear
that the diapers should be well soaked. The baby was 11 days old!! And my
telephone assessment skills did not go far enough as I did not ask that
critical question: "How wet are they---a teaspoon, a tablespoon, or
soaked?") And as for the baby feeding at the breast, he did suck, but when
we listened, we did not hear swallows, another thing that may not have been
made clear to Mom on discharge or that she didn't understand the
significance of. As it turned out, when we put the pump on Mom we got
essentially nothing for the whole time the infant remained in NICU. She had
no significant medical history. We kept her pumping, tried SNS at the breast
for 20-30 minutes and syringe/finger feeding after "breast time" to get the
calculated minimum in him. He was slow and actually took more during the
syringe/finger feeding sessions, but still no great amount. It was a long
haul and Mom never obtained significant amount of breastmilk.
To make a long story short, (too late!) teach clearly and never
assume things are "normal" unless you see it in person and assess
thoroughly. And thanks to all who share the things they've learned here on
LactNet. You may be saving more lives than you know! (For example, Marie
also mentioned that delivery room scales were sometimes not calibrated
correctly. Yikes! That's a simple one that I never would have thought of! I
will now, though, if I see weight discrepancies from birth to day one or
two.)
Jean M.
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