Thanks to the many responses that I received on this very frustrating case.
At this point in time there is no diagnosis on this baby, but I am at home now
and when I go in later there may be some news.
As of yesterday, the baby had finished a pnuemogram, weaned off O2 and the IV
and was breastfeeding again.  The apnea spells have stopped.  All cultures
came back negative so the antibiotics were stopped.  The mother's milk supply is
good.
Our regular neo has been on the last 2 days and I asked her about what the
covering neo had said.  She does not believe that dehydration was the primary
diagnosis and we find it very interesting that this urine sp gr of 1.030 is no
where to be found documented, only a verbal report given.  So what is the sp gr
of pseudo menses?  (my sarcasm!)  Because that is what I observed in a
diaper.  The day after the admission to the Special Care Nursery the urine report
had a sp gr of 1.010 with no red bl cells or white cells.
Prior to this incident the baby had not been on any meds and had no
documentation of any formula given.  Her first 36 hours were very normal in
description.  I stand behind my assessment that the baby did not appear dehydrated, with
moist mucous membranes, good skin turgor and flat fontanels.  There was less
than a 7% wt loss.  Why her sodium went up to 155 I do not understand.
Mother's breast had some fullness on that day and there is no way with what was
happening that at 40 hours postpartum that her breast were starting to wean and
increasing the sodium level in her milk.  I do not know of any meds the mother
was on because I have not had access to her chart (she has been discharged).  I
do know she did not have any antibiotics and was Beta strep negative.

I will post any updates on this case as they come in.
Ann Perry RN IBCLC
Boston, MA

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