The Kid is Losing It
What can newborn weight loss be attributed to in the first 3 days?
A. diuresis of extracellular fluid
B. passage of meconium
C. inadequate intake
D. all of the above
D, All of the above
True or False: Most mothers with flat nipples will require a nipple shield
False, remember it's breastfeeding not nipple feeding
What is a medically indicated reason to supplement with EBM and/or formula?
A. Hypoglycemia
B. Signs of Dehydration (clinical or lab result)
C. Hyperbilirubinemia associated with suboptimal intake
D. Maternal medication or temporary separation of mother and baby.
E. All of the above
E, All of the above
According to the Academy of Breastfeeding Medicine, what percentage of babies born by c-section will lose 10% of their birthweight by day 3?
A. 5%
B. 10%
C. 25%
C, 25%
Excess newborn weight loss is correlated with which of the following:
A. LGA/SGA
B. Positive maternal intrapartum fluid balance (ie more than 2L of IV fluid)
C. Mom was eating donuts in labour
B, Positive maternal intrapartum fluid balance (ie more than 2L of IV fluid)
Flat nipples can be attributed to which of the following:
A. Edema
B. Normal anatomy
C. Mom didn’t prepare her nipples for breastfeeding.
D. adhesions that connect the nipple to the inner breast tissue.
E. history of breast surgery or nipple piercing.
All of the above except C.
What volume of supplemental EBM and/or formula would you offer a baby on day 2 of life?
10-20mL
True or false: Greater than 8% weight loss on day 2 is an automatic reason to start supplementing with formula.
False
What is the first step you can take in caring for a baby who has lost 8% of their birthweight? Refer to Supplementation Flowchart if necessary.
A. Assess a feeding
B. Teach the parents to bottle feed
C. Panic
D. Order a stat CBC and inform the NICU
A, Assess a feeding
What is one technique that may help evert a flat nipple or help a baby to latch on?
Reverse pressure softening (have the PH handout), Stimulate the nipple (have the breast model with the flat nipple), Pull back on the breast above the nipple to aim the nipple upwards. Sandwich the breast, “Pinch up the tissue and place in baby’s mouth” Ensure good positioning (football or prone with baby on top of the breast), asymmetric latch. Pump for a few minutes prior to latching. Apply a cool, damp cloth to the nipple. Reverse pressure softening.
What technique mimics breastfeeding by controlling or slowing the flow of milk during bottle feeds?
Paced bottle feeding
What is the pinch test?
A. when you pinch the baby to keep it from falling asleep
B. when you pinch the mom to test her epidural level
C. Gently compress the areola about 1 inch from the nipple, placing the finger and thumb on opposite sides of the nipple.
C, See picture
You have just assessed a feeding of a baby who has lost 10% of their birthweight. Name five things the nurse can do next (not necessarily in order)
1. Report to the MRP who may consider delaying discharge and/or ordering blood work
2. Assess for signs of hypoglycemia, jaundice, dehydration and report any abnormal findings
3. Review hand expression and/or set up breast pump and ask parent to start expressing milk q 3h 4. Referral to lactation consultant
5. Discuss alternative feeding methods and teach parents how to supplement using the method of their choosing.
6. Other acceptable answers: send to BF class, more skin to skin, ensure 8 feeds in 24hrs, assess output, obtain informed consent to begin formula supplementation
An inverted nipple is one that:
A. Appears flat but everts when stimulated
B. Appears everted but retracts with stimulation
C. Looks like a dimple or an “innie” but everts with stimulation D
C, Looks like a dimple or an “innie” but everts with stimulation D
Cup feeding is thought to help preserve breastfeeding because:
A. baby uses the same facial muscles and the same motions of the tongue
B. baby controls the flow so as not to drink too fast or overfeed.
C. May help bring tongue forward.
D. All of the above.
D, All of the above - demo cup feeding
A Mom with flat nipples should be told which of the following:
A. Babies latch to breasts, not to nipples.
B. Most babies can latch to most breasts; we’ll teach you some things to help you and your baby learn to breastfeed.
C. I’m going to measure you for a nipple shield.
D. You should consider bottle feeding.
A and B
Babies latch to breasts, not to nipples.
Most babies can latch to most breasts; we’ll teach you some things to help you and your baby learn to breastfeed.