> At this time,
> our director is not willing to allow nurses syringe or cup feeding due to
> the risk of aspiration or perforation of the palate.  We have many new
> nurses who have not been trained or are comfortable doing this anyway.  When
> I suggested paced bottle-feeding with a slow-flow nipple, management frowned
> because the baby needs to be fed quickly to get that sugar up.  We are a
> busy hospital and do not have 24 hour-a-day LC coverage.  Any suggestions on
> how to please the parents who don't want bottles used while treating their
> hypoglycemic newborn?

I'm curious regarding the evidence your director is basing her concern
re: risk of aspiration -- or perforation of the palate(! -- good
grief!) on? I'd really like to see the citation(s)! There is evidence
that cup-feeding is safe. I'm unaware of evidence either way re:
syringe-feeding, although if done properly and food is delivered
(slowly) in buccal space, I'm not sure how the palate would be
affected by either feeding method.

And there IS evidence that bottle-feeding (related to flow rate) can
pose a threat to the airway with risk of aspiration, and it's
associated with refluxing and over-feeding (and one study found
over-feeding in the first week associated with later childhood
obesity). A slow-flow feeding-bottle-nipple is an oxymoron if it's one
of the hospital freebies, although one is slower than others.

What a crock of you-know-what re: slow-flow feeding-bottle nipple and
safer bottle-feeding technique vs. feeding fast! If glucose level is
so dangerously low that a few extra minutes for feeding (to protect
the newborn's airway and make the infant feel more comfortable and
less likely to reflux) creates a physiological problem for said
newborn, then that baby belongs in the NICU! Give me a frickin' break!
More appropriate bottle-feeding technique and teat takes only a few
extra minutes and should be a QI issue for any baby receiving fluids
via an infant-feeding-bottle. This is NOT just a BF baby  issue --
it's an airway safety issue that healthcare professionals should be
taking into consideration. Makes me ill what is done to babies in the
name of expediency...

What's the director's take on finger-feeding? I'm sure she'll find
some good excuse for why it shouldn't be done...




Sorry to piggy-back responses but I'm trying to get ready for an early
flight tomorrow...

> I'm working with a mom of twins in our NICU - she has never been able to
>  express more than 5ml at a time, even when switching to the Symphony pump
>  and providing larger flanges. She has never felt a large milk surge. She
> did
>  receive radiation to her spine as an 8 year old for leukemia (which is now
> in
>  remission). Could this radiation have effected her milk production, even
> though
>  it was not directly on her chest?
>
>


Before looking at the history of radiation, would it be possible to
get more info re: length of twin gestation at time of delivery, reason
infants require NICU care, had mom experienced any complications
during the multiple gestation, birth or postpartum? Were twins a
"natural" occurrence or related to fertility treatment -- if related
to fertility treatment, what was the cause of difficulty conceiving?
Was/is she on any medications? If babies were preterm (the usual
reason), what was the reason for the preterm delivery -- nature or
medical judgment related to complications?

How soon did mom get pumping after delivery? What were both her
early/immediate postpartum and current breast-pumping routines -- how
often in every 24 hours, how long does she pump, does she use breast
massage, etc.? What pump was she using prior to the Symphony? Are the
flanges the right size, how does she hold them in place, etc.? Does
mom do any "power pumping" -- and if so, how is that term defined?
Does she keep a log of her pumping sessions -- and does she bring it
in so you can see it?

I've met several MOT who obtained very little milk during the first
couple of months, but they kept pumping and sometime around 9-12 weeks
they experienced a fairly sudden increase in production -- sometimes
was enough, sometimes wasn't for twins or more. Some took
galactogogues in addition to improving their pumping routine prior to
the increase in production, some didn't. I can't always figure out why
production is low initially (although often it's related to inadequate
pumping/milk removal) or who will experience an increase, but I know
if they stop it definitely will never increase.

Have you ever read this case study of a mother of quads with really
poor production and time management issues transitioning 4 premies to
breast, until she became desperate when one had a bad reaction to
every formula tried. She started putting that one to breast and kept
him there round-the-clock for several days, production increased
dramatically and, within a couple of weeks, all were BF -- and did so
into toddlerhood. BTW, I would've bet against this MOM achieving the
BF she did -- we're talking virtually no production for the first 2-3
months. The citation is:
Auer C & Gromada K (1998). A case report of breastfeeding quadruplets:
Factors perceived as affecting breastfeeding. Journal of Human
Lactation, 14(2), 135-141.

--
Karen G
www.karengromada.com/

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