I hope that somebody will be able to guide me in this challenging case.
11 days old baby was admitted on 7th day of life with acute onset of
intractable vomiting several hours prior to admission. During evaluation
in Emergency Department vomiting became bilious and the kid started
passing large bloody mucosy stools. Upper GI series did not identify any
malrotation or other surgical pathology, blood work was mostly benign
and the kid was afebrile.
Baby was born via repeat c/section, some problems with initiation of
breastfeeding because of hospital policies (no comments), so
supplementation was started with bovine milk based artificial
substitute. Went home on day 3 of life, with mother's milk supply
improving with skin/to/skin, as well as frequent feedings and pumping.
Last feeding with artificial milk on the evening of admission.
Mother did breastfeed wonderfully the first baby, who did self-weaned at
6 mo of age when mother's breast milk did change 3 mo into the present
pregnancy. Nobody is sick in the family and there is no history of
recent travel. Older sister had a history of severe eczema.
Baby was started on IV fluids and did well. Follow-through X-rays did
show evidence of allergic entero-colitis, so mother was started on
elimination diet (the proctocolitis website came handy and on time!:D).
Mother was diligently pumping and older sibling was only happy to
consume the breast milk.
Baby's diarrhea and bleeding subsided by the 9th day of life, he did
well on oral Pedilyte and yseterday (day 10) we started re-introducing
breastfeeding. By the 3rd feeding the kid was passing bloody stools
again, to great disappointment of his devoted mother. We did stop
feedings completely and today re-started Pedilyte
Today we got the call from a lab, that his stool is growing (G-d help me
to spell the thing right) /AEROMONAS HYDROPHILA/CAVIAE.
/While awaiting sensitivity, we started IV cefriaxon. //
Through the whole ordeal the kid is stable, afebrile and all labs
(besides the stool cultures) are normal so far.
I will be doing more investigation tomorrow, as I did not see the ID
consult report yet (just spoke with the doc over the phone). When the
kid was supplemented, parents were using ready-to-feed artificial milk,
so the probability of food contamination is low.
We will test both Mom and Dad for the bug. Mom continues to pump and she
is still on the strict elimination diet.
I was not able to find any case reports of this infection in newborns (I
had never heard about this bug to begin with), so I will have to relay
on the collective wisdom of the esteemed international breastfeeding
community - did anyone had any cases like that?
Thank you in advance,
Alla
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative
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