Help fellow Lactnetters - more knowledgeble than I by far when it comes to NICU:

I've been working mostly for the "baby friendly" program in our hospital and
with healthy (more or less) full term babies and helping moms whose babies were
transferred to NICU for the usual infections, prematurity, etc.

However, this case brings a situation that I have not handled yet, and I'd like
your input.

Mom delivered her second baby by cesarean birth after MD discovered slow fundal
growth (mom had skipped some OB visits, I was told, as her previous pregnancy
was unremarkable and she didn't want to miss work.)
[To further explain what you may consider irresponsible behavior - here MD's
don't give appointments.  You come on a first-come first-served basis and you
miss a whole day every time you need to go to the MD. Which is also why I'm
behind on my own checkups.]

"Tom" was born at 2 lbs 12 oz and has had all sorts of chromosomal and infection
checkups.  So far the only diagnosis is "Asymetrical Intra-uterine Growth
Retardation".  And Asymmatrical he is.  The head seems exceedingly large for his
body, (his body looks to me similar in size  to his NICU neighbor who is 30
wks.) which if I remember my nursing school books is actually a good sign that
the baby's head (and brain) grew even at the expense of the rest of his body.
He is now 3 lbs, the parents tell me they were told he is 34 weeks Gestational
Age.  He has no respiratory problems or any other problems after many tests.
However, he is being fed by Nasogastric tube as he has "no suck" according to
the MD and nurses.  Parents asked me to see him, which is how I ended up doing
an assessment.
These are my findings - but I would love to have some input into what else to
assess or what else to do for him:
1. Lower jaw is receeded, appears to be underdeveloped.
2. Hard palate seems very high.
3. Weak infrequent sucks elicited with finger stimulation, and only once did I
see a swallow.
4. Cup feeding wakened him and he appeared to try to want the liquid (mom's milk
- she's doing a great job maintaining milk supply.) in his mouth, but again no
swallow.

I wonder if the presence of the NG tube - so large in such a small throat -
would inhibit the swallow.  In fact, could it be causing the problem of no
swallows?  Tom seems to have a very weak gag reflex, which I assume could be
caused by the constant presence of the NG tube.  - or am I all off base?  HELP

I assume he needs a trained OT or PT, but there isn't one with NDT training in
our hospital (in fact I only know one in PR).  I would dearly have loved to
attend the suck conference held recently in Arizona, but the cost of travel from
PR added to the conference and stay...  What can I do for him?  And more
importantly - what should I be very careful to avoid? - First Do No Harm!

Thanks for your help!

Jeanette Panchula, BSW, LLLL, IBCLC, RN
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