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