This is a subject near and dear to my heart. I do crunch numbers and I find
them very useful. I do look at the big picture and take all factors into
account. The factors are many and that is why lactation consulting or
sorting out breastfeeding problems is not simple, and why maternal and
infant and cultural and family and other factors come into play. We
certainly should not just look at a number like 10 or 12 or 7 percent and
say "oh we need to supplement."  Sometimes supplementing means "give
formula" and sometimes supplementing means "give some ebm." Maybe we should
say "this baby needs more milk" instead of this baby needs to be
supplemented. In my experience, I certainly do find that the higher
percentages of weight loss are virtually always correlated with a baby who
needs more milk. My population are moms who have routine IVs and pitocin
and certainly have some edema. While I respect the research that is showing
us evidence of baby's getting some of this fluid and pee'ing it off,  I
don't find that it can totally explain the weight losses I see.

I run the percentages all the time. the formula fed babies almost always
lose 2 to 3 percent and some gain an ounce prior to discharge. The
breastfed babies usually lose 4 to 7%. The ones that are having trouble are
usually losing 7-9% or so. The ones who come to clinic and have orange pee
and no stools and moms with delayed or low milk production usually have
lost 11 to 14 %. This is just my experience. I don't just go by the number
but the total mother/baby assessment, of course.

When babies who need more milk are given what they need (ebm, or formula if
mom doesn't have enough milk), they typically gain 4 to 8 oz overnight. I
know because I see them on pediatric unit (weigh them myself, same scale)
or see them in followup clinic next day. Accurate weights are extremely
important. Babies should be naked (duh).

I'll give you recent example. A baby had a tongue-tie (not clipped until
few hours before discharge) and was exclusively bf and not supplemented
other than ebm (4 to 6 mls each time). Baby was having some latch problems
and requiring phototherapy early. (our doctors don't start phototherapy
unless baby is in high risk or high intermediate category so baby did
really need it). Next day baby gained 5 oz.  I questioned the weight, of
course. It was wrong I assure you but the nsy elected to just re-weigh next
day. Next day it was down 9 oz (privacy reasons I'm not giving more
detail). This was a 7%wt loss. At discharge baby was latching some feeds
others receiving pumped milk. Milk was in and mom could pump 2 oz each
time. This baby did not need any thing more. Baby had followup appt
scheduled. This baby was closely followed in hospital and helped as much as
needed and roomed in.

The percentages are meaningful to me as I look at them and the bilirubin
levels at discharge and at followup. It's just part of the total picture. I
am sure that being a nicu nurse in a very highly regarded and fastidious
unit affected my attention to numbers and details.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome