I was also at their conference this past week, sorry I did not get a chance
to meet Nikki.  It was a wonderful two days and all ready I have put it to
use.
A baby born this week, full term, primip mother with well controlled
gestational diabetisis.  Had c-section for breech presentation.  Mom and baby
separated, mom in labor & delivery waiting for a room and baby in nursery
(SIGH ! :-((( )  Baby brought to mom to nurse with a low blood sugar.  Baby
not interested in nursing, sent back to nursery to be supplemented.  Now, I
come into the picture.  Tried to hand express some colostrum but could not
get enough, mom did not want baby to get any bottles.  I went up to nursery
to try cup feeding but the neonatologist seeing the baby would not let me.
Baby has a very high bubble palate, the tongue extends over the gum line but
has short frenulum pulling the tip into a fork.  Baby has an extremely
hypersensitive gag.  Keeps it's head in a hyper flexion position, which the
neo thinks is from the breech position in the uterus.
I watched as they attempted to feed this baby a bottle of formula.  The baby
did not form a seal so formula leaked all over the chin, the tongue motion
was a compression type not a sucking.  There were a few compressions, with
breath holding then the baby would have pause with rapid breaths to catch up.
 Then they would encourage more intake and then the baby gagged and retracted
and breathing/crying with strider.
This was so difficult to watch.  They stopped the feeding and transferred the
baby to a Level II nursery, started an IV, placed an NG and I set mom up with
a pump.  An x-ray of the throat was taken but did not show much.
The next day mom came to breast feed baby still has strider and prefers to
keep head in hypertension.  After a couple try ended up using a small nipple
shield and baby latched and nursed, had very few swallows but did not drop
her O2 levels or any apnea spells.
IV had been d/c today and was breastfeeding with PG feedings through the NG.
On a pre and post weighing baby only took in 2cc but I think that is all this
baby can handle.  I did listen with a stethoscope and could hear the
breathing with sucking but very little swallowing.
They plan to send the baby for more test Monday, including a swallowing study
but waiting until mom is d/c to go with her.
I'll keep you all posted.
Ann Perry RN, IBCLC
Boston, MA

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