A while back I saw a 6 day old infant for breast refusal. Infant had
been born at term weighing just over 6 lb.
It was late afternoon. Baby was sleepy upon arrival. When infant was
awakened, he would suck 2-3 times and fall asleep. Digital suck exam
revealed normal tongue and palate. Mom readily expressed mature
appearing breast milk, but infant showed little interest.
As I worked with mom and baby, I ascertained the following history. Mom
had tested positive for group B strep during pregnancy and had received
2 doses of penicillin I.V. during labor. Infant had an uneventful
hospital course and breastfed well. At 3 days of age, infant stopped
breastfeeding. After numerous attempts throughout the day during which
infant did not eat for 17 hours, mom began hand expressing milk and
bottlefeeding it to the baby. She awakened him about every 3 hours and
fed him all the milk she expressed. On the day I saw him (at 6 days of
age), he had taken 1 1/2 oz. (90 ml.) at 8 a.m. and had bottlefed very
poorly in the early afternoon.
As I worked with the baby, I noted a weak, high-pitched cry and became
very concerned about a term 6-day-old infant who did not awaken on his
own for feedings. After several very poor attempts at breastfeeding,
his respiratory rate was 70 (I would have expected a healthy baby of
this age to have a rate of 40-50 at most.)
I called the doctor. Mom expressed milk while waiting for a
call-back. After talking with the doctor, I accompanied them to the
emergency room. Mom fed baby the expressed milk while waiting in the
emergency room. Infant was admitted to a pediatric intensive care unit
and was hospitalized for several days. Final presumptive diagnosis was
a viral infection, as all tests were negative, despite the fact that the
baby was extremely ill, requiring central venous catheter placement.
I praise the Lord for showing me that this was a medical problem and not
a breastfeeding problem. Last report, at two months of age, baby is
healthy and being exclusively breastfed.
--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
mailto:[log in to unmask]
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