Our hospital based lactation program was called to consult (3 days ago!) on a
primiparous mother/baby on day 2 post ceserean. Baby had been latching poorly
and had been "worked up" post delivery d/t borderline low apgars, somewhat
poor muscle tone -with negative results. On day 2, output was on the low side,
color was beginning to jaundice,.wt. loss 7% and latch success was minimal. Mom
was started pumping and discussion ensued regarding supplementation-parents
were resistant.
I saw the baby early am day 3 and   again later afternoon d/t my nagging
suspicions that something *wasn't right *. His color had become slightly more
jaundiced over the course of the day but what disturbed me was that it was a
rather sallow tone of jaundice mixed with some circumoral cyanosis.   Parents had
decided to suppmt overnight with formula and my attempts to assist at breast x
2, met with little improvement despite offering small amts of EBM via syringe
while latched to incent . He was not tachypneic or tachycardic, had alert
periods mixed with irritability but remained limp.   I did mention his color to
his nurse but my vague intuition that something wasn't right was hard to convey.
I left parents taking pictures of baby STS and with plans to see him as first
consult next day(yesterday) before their discharge.   am yesterday baby was
transferred to NICU after being found limp and grey by RN in bassinette. Mom
had just finished attempting at breast and followed up with 1.5 oz formula. Upon
my arrival to NICU baby was ventilated , in poor condition with diagnosis of
 hypoplastic left heart .
 Upon reviewing this case in my mind, a few things stand out as important to
share. Number one is trust your intuition!
Despite having a long history in neonatal care (including a pediatric cardiac
unit!), I did not feel confident enough as the "LC" to offer more of a
clinical opinion.. Also, it refocused my attention to the fact that as LCs, we often
spend more TIME with individual babies than *anyone* else   AND we see
Moms/babies that are having difficulty feeding.   Any ill infant will have
difficulty feeding, thus our focus group is already slanted towards the potentially
sick and requires vigilant attention to the possibility that there is something
more to the story.
For all who are not familiar- hypoplastic left heart means that the left side
of the heart didn't develop and thus is not functioning properly . ONce fetal
circulation finishes its evolution to newborn circulation (usually within a
few days),   the infant is left with little blood flow to the body. If the baby
lives beyond the first week of life, it requires surgery-either heart
transplant or multiple stages of correction. This was the 2nd such diagnosis in our
hospital in the last 2 weeks.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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