Cindy,
Babies with cardiac defects frequently tire easily and burn extra calories
with feedings.  Breastfeedings can be less taxing to them, but unfortunately the
breastfeeding gets blamed first frequently when the baby doesn't gain
adequate weight, and the bottlefeeding is seen erroneously as less stressful.  You
are right that breastfeeding is less stressful physiologically according to the
research.  But, frequently the calorie needs of a cardiac baby are higher than
normal, and the baby's lack of adequate weight gain are as a result of less
than optimal calorie intake.

I'd recommend the use of a BabyWeigh Scale to accurately measure intakes on
this baby for all feedings, thus supplementing accordingly.  I just picked-up a
scale from a mom of a cardiac baby yesterday who is now 6 months old, post 2
cardiac surgeries with 1 more scheduled tentatively for January, and the baby
is growing and thriving.  The mom had support from her LLL, her pediatricians,
and her commitment level.  She used the intake recordings to battle her
baby's cardiologist who wanted to see proof that the baby was getting enough
calories with breastfeeding.  I had nothing more to do with this particular case
than to rent her the use of the scale.  But, the scale use in a cardiac baby can
be very valuable.

I had a consult today with a couple's new baby who have a daughter now 7
years old born with cardiac defects.  She didn't have a lactation consultation, no
use of the scale, and she was told to wean her daughter.  The parents told me
they wish they'd been able to breastfeed her longer because she subsequently
has been diagnosed with anemia and an autoimmune condition requiring the use
of a port to administer immunoglobulins.  Once I help mom to get her supply
increased, I'm going to recommend to her that perhaps she'd like to give her 7
year old her breastmilk in a cup.

Another thought I just had regarding the cardiac baby's oxygenation needs.
Cardiac babies have lower oxygenation parameters until their defects are
corrected.  Instead of an O2 sat. value of 95 or greater, the docs usually want an
O2 sat. of 90 or greater.  They cannot and will not oxygenate more efficiently
until the surgical repairs, thus feedings may cause a drop in O2 sats and a
rise in oxygen needs regardless of mode of feeding (breast or bottle).  Simply
raising the oxygen % during the feeding, assessing for resp. distress signals,
allowing for breaks during a feeding will cause these babies to get nourished
without undue stress.  A sign of distress is when the baby desats unrelated to
feedings, such as during a quiet alert state and/or sleeping.  Then the docs
get concerned about the baby's status.

Oh, and I almost forgot about the Down's condition.  Are you using the dancer
hold to support this baby's jaw while breastfeeding to make-up for the low
tone?  And, positioning baby in an upright position to facilitate dropping the
tongue down and forward.

Good-luck!  Keep us posted!  Mom needs lots of tlc to keep on with this baby
because this baby will optimally thrive on breastmilk.

Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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