Jeanette,

I am a NICU nurse yet I hesitate to assess anything over the internet. If you
are concerned, by all means get another opinion. So often a nagging feeling
that things are not quite right are born out.  One thing does catch my eye
about this case, however. You report really excellent wt. gain in the first
week yet describe a baby who stays on the breast for only a short time to
accomplish this. This immediately makes me think mom may have oversupply with
accompanying forceful MER.  I recently saw an outpt. several months old who
nursed with just this pattern.  I likened it to drinking from a fire hose.
Baby gamely swallowed and swallowed and swallowed without a break to breathe
until she finally pulled off to catch her breath, huffing and puffing. Mom
was very worried about this and also that breastfeeding was not very
comfortable for the baby. Certainly suck, swallow, breathing coordination
should be well developed at term but in the face of rapid let down I think
baby just tried to keep up with it. There seemed to be no way she could fit
breathing into the picture, so huffed and puffed after.  The fact that your
baby stays pink, has no other signs of respiratory distress such as flaring
and retracting and is gaining so well is reassuring. Sixty is a normal
respiratory rate for a newborn.  With the mother I was working with I had her
use measures to bring supply down...one breast for one to two feeds.  I saw
her a week later and baby was doing much better at the breast, only breathing
fast at the beginning of the feeding.
Let us know how your case turns out...a great learning experience for all of
us.

Also would probably be important to make sure both nares are patent.

Kathy Boggs, RN, IBCLC
Packard Children's Hosp. at Stanford

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