hi, just a quick intro. i'm an IBCLC (10 years) in New Zealand. i have worked with families for the past 25 years as a registered nurse, child health nurse, midwife, lactation consultant and childbirth educator.
i work part time as an IBCLC in two hospitals and i also have a private practice.
any ideas on the following case would be greatly appreciated. this has been the most challenging case.
normal pregnancy, spontaneous labour at 39/40, normal birth, no drugs, apgars 9 & 10, bw 3760g, breastfed well at birth. (this is the mother's second baby and she had successfully breastfed into the second year).
baby started to be fussy at the breast the next day- was given ebm/expressed milk via cup.
seen on day 3 by me. tending to sleep too long between feeds. mum gave baby some ebm and then she was observed to feed beautifully (rhythmic suckling & swallowing) at the breast awhile later.
once home, baby fussy plus plus, not latching let alone sucking. very resistant going to the breast (a patient, gentle mum). mum expressing & feeding via cup but baby not cup feeding well thus not achieving adequate volumes.
i visited on day 11. assessment as above- cup feeding not working- attempted finger feeding with some success but decision made to use the bottle- wouldn't take this initially either but with coaxing & rocking etc, she drank a large volume. oral assessment & physical-NAD-alert & settled.
the next evening, mum distressed due to inability to get baby to drink anymore than a small volume- i visited at home at feed time & felt baby was struggling to co-ordinate suck-swallow-breathing. referred to paediatrician for a full assessment the next day. he felt her heart rate went up on feeding and sent her into our children's hospital for further assessment. had cardio-pulmonary assessmnt, chest x-ray, ECG- nad. day 16 visited, weight 3440, baby got sick with a bad cough & cold after this- feeding was a nightmare. as i said, this baby could breast & bottle feed beautifully but her normal approach at this stage was approx 50-70ml of breastmilk via the bottle & it was sooooooo slow.
day 18 3500g, day 20, 3480g. awaiting speech language therapist input- she suggested the chu-chu & squeeze bottle first- not much better, need to start a hauberman. spoke to further paediatricians- went for an assessment with another-hauberman started-not alot better even with extra calories added to mum's milk (60g gain- weight-3460g) - decision to insert a nasogastric tube- day 24, using this plus hauberman. baby continues to show minimal interest , resisting, occasional spill, otherwise looks & acts normal.
approx 2 weeks later she refused the hauberman and started very small breastfeeds with most of feed via the n/g tube (still extra calories added)
baby is nearly 3 months old and things continue on as above - longer breastfeeds and occasionally no top up via the tube- still close supervision by paed, community team and myself
baby now 3 1/2 months old; this week she has started to have 1-3 feeds from the breast which don't necessarily require top-ups via the n/g tube. she is growing albiet slowly (4440g at 10 1/2 weeks- can't remember the latest weight), developmentally- interactive, smiley, interested, muscle tone is excellent.
i'm keen for the baby to have some further tests- paed has agreed to these.
any ideas please- this case has got me stumped.
regards trish warder
IBCLC
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