Dear Lactnetters,
I am trying to establish some kind of guidelines to use when the nurses
and/or doctors decide that a baby needs supplementation.  Often babes
refuse to nurse for a few days and at some point, hopefully after the first
24 hours, someone starts "feeding" the baby.   We also are ordered to
supplement if the bili level is high or if babe has lost greater than 10
percent.  Certainly addressing the latch and frequency are important but
I'm also concerned with a relatively sensible approach to how much to give
and how to decrease that as the mother's milk volume increases.  I searched
the archives and came up with several approaches ranging from 13cc per feed
based on physiologic size of the stomach (we don't usually supplement a
baby on the first day if he is refusing to nurse provided temp etc. is
normal) to 45 cc based on 10-15 cc per Kg.  That's a huge range which is
just about as inprecise as what the nurses are doing now, which is based
more on the nurses preference and the babies willingness to take it than
need.  Do any of you have specific guidelines you follow in these cases
that might be of help?

Thanks
Jennifer

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