It sounds like this mom has an oversupply with such a high weight gain, baby coming off the nipple and mom pumping 2x a day. Green mucous stools are a clue as well. I see colitis under these conditions. Gail Hertz [log in to unmask] On Jan 30, 2013, at 8:05 PM, Michele Crockett <[log in to unmask]> wrote: > Hello, > This seemed a bit more complicated than normal...although now that I have > written it all up I am feeling more comfortable. I would appreciate any > thoughts that might help this mom and baby. Mom is pretty intense and I > may have picked up on that. Sorry it's a long report! > PTP: 12/12/12 Very healthy woman with preterm labor at 34 ¾ weeks w/ baby > breech. Received mag. sulfate to stop or slow labor. C-sect timed to > arrive with med. helicopter due to rural hospital. Baby sent to hospital > w/o parents for 3 days when mom was released from local hospital. BW was 4 > lbs 7 oz; apgars 8 & 8. She developed some respiratory distress and was > stabilized on NCPAP. All respiratory issues resolved and baby was > discharged 1/11/13 breastfeeding and supplementing with Enfamil. All > neonatal screening was negative. Mother noticed blood in stool on 1/21/13 > and took baby to ER. Blood was verified in stool, all other blood work and > ultrasounds were negative, and believe me they did a lot of tests! Mom > told to give baby only breastmilk and if needed use Nutramigen. More blood > in stool observed a few days later and local MD office screened stool for > e.coli, etc…again all negative. > > > > Mom contacted me via phone once home. I was unable to meet with her due to > being out-of-town until today. Discussed BN positioning which mom tried > and is now using almost exclusively. Milk production does not seem to be a > concern at this time. > > > > Mom has been pumping 2x per day, however mostly direct breastfeeding with > one/two bottles of bmilk in 24 hours for mom’s stress relief (hx of > depression). She is currently taking 50 mgs of Zoloft. She is using > nipple shield which she would like to eliminate. Baby’s weight gain has > been 10-11 oz per week for the last 3 weeks (2 of which are exclusively > bfed). Mom is taking prenatals and baby is taking PolyVi-Sol 2X per day. > > > > I observed a nursing first as baby was being held off by grandmother when I > arrived. Mom used shield and baby latched with chewing at first, then with > let-down began active sucking, mom was using breast compression and baby > began to pull off but came back once I suggested mom not compress. After > let-down baby began to pull off then on then off then on. When baby began > dozing, I slipped the nipple shield off and she immediately latched on the > bare nipple and nursed with active swallowing for a few minutes then began > the off and on again. Nipple appeared normal when baby was removed. When > baby roused she latched on the other breast when I helped with ‘nipple > sandwich’. Baby went on to nurse well with lots of swallowing. When she > came off the nipple there was an elevated white strip across the face of > the nipple. > > > > Oral exam revealed all the classic ankyloglossia signs and I could clearly > see and feel a thick, tight posterior frenulum as well as a pronounced lip > frenulum. Breast exam WNL. > > > > We discussed discontinuing vitamins (mom and baby). There is family hx of > milk protein sensitivity and mom started avoiding all dairy 3 days ago. Other > than green, mucuosy stools which do not have an odor; baby is growing well, > no colic or distress, no diaper rash or redness around anus. Local ped. is > suggesting a refer to GI doc. While mom is anxious to be off the nipple > shield, we discussed possibility of developing nipple damage and with her > anxiety she decided not to tackle that at this time. I did recommend > letting baby latch/be at breast after & between nursings to continue to be > willing to latch on bare nipple. We are working to get her in to for eval > for tt and frenotomy as soon as possible (more travel for mom and baby). I > could not find anything that indicated that Zoloft could cause GI distress > in baby…mom would be willing to lower dosage or eliminate if that was > possibly causal. (Mom is feeling quite traumatized by the NICU experience) > I have let mom know it can take several weeks for dairy to clear mom’s and > baby’s systems. I am thinking she was sensitized due to cow milk exposure > to an immature gut and mom’s dairy intake triggered the GI problems and > maybe the added iron via vitamin supplementation. So what I have missed? Any > other ideas of what she could try? Do you think Zoloft is a concern? > > > Thanks for any input! > Michele > > > -- > *Michele L. Crockett, IBCLC, PCPA, LLLL* > > *********************************************** > > Archives: http://community.lsoft.com/archives/LACTNET.html > To reach list owners: [log in to unmask] > Mail all list management commands to: [log in to unmask] > COMMANDS: > 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail > 2. To start it again: set lactnet mail > 3. To unsubscribe: unsubscribe lactnet > 4. To get a comprehensive list of rules and directions: get lactnet welcome *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome