Supplementing ?

[RN520]

I'm a PP nurse, and at our hospital, we weigh our babies during the night shift. If they're at 9% weight loss, we have our breastfeeding moms supplement. One of my breastfed babies this week had a 7% loss as of last night. Ordinarily, I'd just pass this on to the day shift and let them know to be watchful, make sure the mom is nursing regularly, etc. However, this baby was SGA (5-13 and 18.5", delivered at 39.5) and because of that, my gut said "Supplement now." The pediatrician had already written d/c orders, so I knew the baby would be going home today (1/24). I wanted to make sure the baby didn't lose any more weight, and offered it as an option to the mom. She was okay with it.

I feel like I did the right thing. What would you have done differently?

[melmarie23, MSN, RN]

We supplement at 10% or more. Our pts have two options: donor human milk or formula. If the wt dropped to that on the anticipated d/c date we will either re weigh in 12hrs or send them home with a skilled VNA who will do a weight check the next day.

[melmarie23, MSN, RN]

How well was the infant feeding? Was mom's milk coming in? How was the infant's TCB/serum billi? I wouldn't have necessarily have had them supplement at 7% if the feeding a otherwise looked well and we're anticipating mom's milk coming in soon. I'd still relay to the pedi that a wt check would be prudent though just in case.

[queenanneslace, ADN, MSN, APRN, CNM]

Not sure if I'm allowed to link to outside sources or not - or which ones are allowed or not.

But I appreciate the perspective in this article written by a pediatrician and IBCLC regarding newborn weight loss.

[Marymoomoo]

It is concerning when a newborn is losing weight, especially a newborn that is small to begin with!

As other posters have mentioned, some weight loss is common. The longer the mom was on IV fluids, the greater baby's weight loss. There have been many recent studies on this. Don't forget to include that information when you're evaluating newborn weight loss.

Rule #1 (ALWAYS!) is feed the baby. Of course, you want to be certain that the baby gets all the necessary nutrition. That said, formula really should be given only when it is medically indicated and not as a first resort. What else could be done to assure that this baby doesn't continue to lose weight?

The first thing I would suggest is to assess a feeding. Was baby latched on well? Was mom comfortable? Was baby getting milk? Was baby wetting diapers and stooling? What color was the stool?

What about skin to skin contact? Was mom holding baby in kangaroo care as much as possible? Not only would this help her baby be encouraged to nurse more frequently, it would keep baby warm and calm (important to reduce weight loss), and help mom's milk production.

What about other things like limiting visitors (read: distractions that often lead to missed feeding cues and baby "shutting down")?

You could also recommend hand expressing after feedings and "topping off" with colostrum which helps to 1) assist the baby in getting more milk (energy) for his efforts and 2) helping mom improve her milk production (short and long term).

Babies that are low birth weight usually have thin buccal pads which makes breastfeeding a bit more challenging at first. Nursing frequently, topping off with colostrum hand expressed after nursing, and even a little structural support from mom can help.

Here's an evidence-based resource regarding when/how to supplement the breastfed baby in the hospital http://www.bfmed.org/Media/Files/Protocols/Protocol%203%20English%20Supplementation.pdf

[IrishIzCPNP, MSN, RN, APRN, NP]

I'm a PP nurse and at our hospital, we weigh our babies during the night shift. If they're at 9% weight loss, we have our breastfeeding moms supplement. One of my breastfed babies this week had a 7% loss as of last night. Ordinarily, I'd just pass this on to the day shift and let them know to be watchful, make sure the mom is nursing regularly, etc. However, this baby was SGA (5-13 and 18.5", delivered at 39.5) and because of that, my gut said "Supplement now." The pediatrician had already written d/c orders, so I knew the baby would be going home today (1/24). I wanted to make sure the baby didn't lose any more weight, and offered it as an option to the mom. She was okay with it. I feel like I did the right thing. What would you have done differently?[/quote']

I wouldn't jump to supplementing. I would be assessing feeds for proper latch and transfer. I would be looking at baby for upper lip tie or tongue tie. I would be looking at number of wet and dirty diapers. I would look at the delivery history.

I would not request mom supplement without looking at other issues....especially at 7%.

Lots of other stuff to look at....

[DalekRN]

We don't supplement without a physician order or moms request. As an RN It's not my call.

[Elvish, BSN, DNP, RN, NP]

Nah, not at 7%. We don't even bring up supplements until they hit 10% or more. Agree with other posters....so much to consider. Is mom an experienced breastfeeder? Will she have fairly immediate (1-2 days) follow-up after d/c? What about baby's output? If the latch is good, you're hearing regular swallowing, baby's mucus membranes are moist and output is appropriate for age, then there's really no good reason to supplement. Sometimes even if we have a kid who's at 10% but output is above what we'd expect, bili is ok, doesn't look dehydrated, and mom's milk is coming in, we don't worry or suggest supplementation. If mom wants to pump or hand express, that's great, but if it's obvious that baby is transferring milk our pedis will often leave well enough alone. Some kids will hit 10 or maybe a bit more and then turn the corner fairly rapidly. (IV fluids during labor is also a good thing to consider, as a PP suggested.)

[cassie77775]

We don't supplement unless mom requests or the dr orders it based on high bili levels etc

[Nineteen84]

Second all the previous posts. We don't blink an eye unless we hit 10% and I believe I read somewhere that 12% is even used as a limit in some locations. And like they said, it's not just the number with there being so many other factors to consider. In addition to above responses, I might consider having a mom pump. Yeah yeah the pump isn't as good as baby but if she can get something, it boosts her up, you show her how to give it to baby. If she doesn't get anything remind her that's totally normal but the stimulation is a good thing too. Maybe she can feed baby, put kiddo skin to skin while pumping (hands free with a belly band and baby tucked inside is wonderful), and then pump after unsuccessful or all feedings (depending on the situation).