This morning I saw a 3 w.o., with hx cardiac surg.. Baby was born vag after
an uncomplicated labor ,birth wt. 9#5oz.  Day 3 baby underwent an
angioplasty; on day 5 baby was operated on and a shunt was placed between his
aortic and pulmonic valves. Baby is now home fed mainly via NG tube as he
will not suck.  Mother is double pumping x7/24 hrs. obtaining 20oz/24hrs.  Wt
today 9# 4 1/2oz.  Baby is fed 90cc every 3 hours, combination of approx 20
oz of ebm and 4 oz abm/24 hrs. Baby is on Lasix, Baby ASA, vitamins and iron.
 Mother offers/attempts  approx.20 cc via bottle with regular nipple for 20
min, then completes feeding via tube.  Prior to discharge baby was offered
breast twice and suckled per mom., since then he is weaken and appears to
tire easily. As mentioned he will not suck. When mom offers the breast he
just lays there. .
 After I encouraged him to briefly root, I introduced my gloved finger into
his mouth, he suckled two or three times with his tongue back in his mouth
and then stopped.

Could baby be orally defensive from all that has been and is still in his
throat???   If yes, how to overcome?? He tires easily due to his cardiac
condition.  The doctors do not want him to cry or feed too long.  His intake
is very carefully measured and coordinated  with his Lasix.
I also wonder if baby will have decreased iron absorption due to the extra
iron prescribed and the supplemental abm containing iron???
I suggested  1.mother give pacificer(hope that's not a no-no) during NG
feedings to associate sucking with feeling of full stomach 2. Lots of skin to
skin contact, 3. Allowing baby to suck on mothers clean finger a few time a
day, hopefully to open option of finger feeding if need be 4. Continue to
offer breast and allow baby to lick, taste expressed milk.

I have very limited experience in this area. I am hoping your collective
wisdom will offer some guidance.  This mom nursed her 2 y.o. for 15 mos and
knows how wonderful nursing can be.
PLEASE< e-mail me privately or to the list asap.  I will keep you informed.
Elisa Hirsch, RN, IBCLC
Westlake Village, CA
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