HELP, especially physician members:
        I was labor support for my friend last night.  She had PROM (48
hours), 100.4 degree F fever, and fetal tachycardia (180 baseline with no
beat-to-beat variability) and a positive group B Strep culture.  Maternal
fever resolved with acetaminophen 1000mg and fetal heart rate improved with
left lateral recumbent position and O2.  The midwife and OB pushed the labor
with pit and encouraged strenuous pushing, and baby girl was 7/9 (1/5 min
Apgars) with no tachypnea or evidence of infection.  After vigorous suctioning
for thick mucous, and examination, baby went to mom for about 30 mins of
snuggling and attempt to bf.  Baby did not latch, but did mouth the nipple a
tiny bit.  (Mom is a LLL Leader).  I was concerned by baby's failure to cry
when seperated from mom for medical procedures, she did not seem really "with
it".
        After seperate exams by ped resident, neonatology fellow, and the
attending ped; baby was transported to Intermediate care nursery and started
on iv antibiotics.  After recovery, mom went to NICU to nurse, and it took her
1.5 hours to encourage baby to latch, baby sucked 20 mins "but it didn't feel
right, it felt like she was chewing a bit."  Two hours later, mom got baby
latched again and baby fed for 25 mins.  Change of shift occured and nurse
took baby as all babies must be in isolettes at change of shift (hosp policy).
 Mom did not have a chance to burp baby.
        When mom went back to feed again, baby had a small amount of curdled
milk and yellow-brown fluid on her face, as if she had spit up.  Nurse said
that new babies are often "juicy" and not to worry.  Baby refused to latch at
all at this feeding as well as the next 2.  The next time mom went to feed,
the resident ped had put baby on npo (nothing by mouth for the latin and greek
challenged), solely due to the labor history.  The same resident told mom
"don't worry, you have no milk to feed her yet anyway."  I advised mom to
pump, and she got plenty of colostrum.
        The babies cbc was positive for B strep this morning(Fri.), though the
culture will not be grown out until Sat pm.
        The resident is telling mom baby will have to stay 7 days instead of
the 2 days they were originally told.
        Mom is angry at the npo status, and does not know if this is
warranted.  How long is iv antibiotic treatment warranted for an infant with
this history?
TIA.
Catherine Watson Genna, IBCLC