Hi Suzie,

In my work in nicu I have seen docs add various amounts powdered
formula to regular formula to make a higher calorie formula. There are
all sorts of 'formulations' to get higher cal, higher protein etc for
specific nutrient needs. Then there is the adding of fortifier to ebm
for certain groups of premies. I figure the doc is familiar with these
sorts of manipulations and I will give the benefit of the doubt that
s/he is trying to continue the bf while adding nutrients to the baby's
diet in the way s/he knows how.

So what I would want to know is why does a baby have wt gain issues
when his mom has ample supply?  So that is where your IBCLC detective
skills come in. I recently posted on a baby who was not transferring
milk via bf, so as sad as it was, we had to pump milk and feed it to
baby (who was under birthwt at 8 wks) to prove that once an adequate
amount of milk went in, the baby would gain, and she did.
If a baby is actually getting an adequate amount of milk and is not
gaining, then one looks to metabolic, sepsis, cardiac etc issues.
I would try to investigate with your client what is the likely cause
of the low gain, and then you could approach the ped or have her do
so, with a proposal to ensure the requisite amt of breastmilk is going
in (not nec. taking baby off breast, depends on situation) and you
will monitor closely like every 48 hrs. Most docs would be open to
that.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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