It sounds like this mom has an oversupply with such a high weight gain, baby coming off the nipple and mom pumping 2x a day. Green mucous stools are a clue as well. I see colitis under these conditions.

Gail Hertz
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On Jan 30, 2013, at 8:05 PM, Michele Crockett <[log in to unmask]> wrote:

> 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*
> 
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