Re: [ozmidwifery] Re: feeds in 24 hours....

[Marilyn Kleidon]

No Jo we don't do gastric lavages routinely anymore (not since I have been here at least in 2002). Though have known some midwives to do this on the ward to mucousy babies. This baby would have been suctioned on the peri and since he was vigorous no further tx was required. He wasn't mucousy either but had refused to feed immediately post birth but had fed well apparently on the night shift and had  3 apparently good feeds on my shift in the first 2 hours: well latched sucking and swallowing for 5 to 10 minutes at a time. I was feeling anxious about doing the BSL because I was anticipating an arguably normal result in the 1.8 to 2.2 mmol/L range bub seemed stable but borderline jittery and to be honest mum was more concerned than I was. Good lesson in "listen to the mother" who can often be written off as overly anxious. Anyway I am glad I listened to mum.  Of course if this baby did have a good counterregulatory response going on then nothing needed to be done. From my understanding of the WHO document we just don't have the documentation on the truly normal range of BSL's, we also don't have really clear signs of abnormal symptoms at least until they become catastophic and you can't miss it. I mean "jittery" can mean different things to different people it is just not a very precise term but tachypnia, tachycardia, bradycardia, hypothermic etc. are clear as is low BSL. Fortunately or unfortunately i will have a lower tolerance of "jittery" for a while to come and can actually still understand the thought behind protocols that require routine BSL's (which seem to vary from 3/24 to 6/24 to random before feeds within the first 12 to 24 hrs) for babies at risk of hypoglycemia.  I can imagine that those midwives and paediatricians who work in intensive care nurseries and see the babies who are missed and have gone into comas etc. including those babies with unsuspected rare metabolic disorders  can see no harm in routine testing. I am just prolly overthinking this one for a while.   marilyn ----- Original Message ----- From: JoFromOz To: [EMAIL PROTECTED] Sent: Thursday, December 16, 2004 4:33 PM Subject: Re: [ozmidwifery] Re: feeds in 24 hours.... Marilyn Kleidon wrote: Thanks Tina: you've actually posted that before 'cause I had copied it and pasted it into my breastfeeding research file!! Found it when I went to copy it again!! I have read the whole thing a few times now and am somewhat reassured that the baby I referred to with a BSL of 0.6 mmol/L may have had a good counterregulatory response going on since he only had "soft" signs of hypoglycemia: some jitteryness and slightly increased irritability. Still unsure of why his BSL would be so low (even supposing mum had zero colostrum) as his intrapartum stress could not be interpreted as intrapartum asphyxia in any way.  I now have a high index of suspicion that mum may have actually been gestationally diabetic despite her reassuring/non-glucose impaired GTT. In which case it would be a transient hypoglycemia and the lab results should show  hyperinsulinemia right? I hope so. I have been off since so i don't know if the hypoglycemia recurred which would be the case if baby had some rare metabolic disorder right? Sorry, thinking zebras now (instead of horses, when I hear galloping).   regards   marilyn Just thinking about this... this baby was born into Mec, right?  Was it policy to do a gastric lavage pre- first feed?  If so, this could be why the BSL was so low... Jo.