Wendy wrote:"Can video fluoroscopy done at the breast with an SNS? I
have a mom who's babe is being treated for post-op= TE=20 fistula
aspiration probs and she desperately wants him at the breast as m=
uch=20 as possible. As of now he has a NJ tube(not ng) and they will be
doing m= ore=20 swallow studies soon. Babe is 3 1/2 mos. and mom is
pumping and he's bei= ng=20 fed via tube but mom's desperate for the
closeness of nursing."

Firstl, if a NJ tube is being used rather than ng or oral feedings, that
is leading me to belive that the baby is either not able to tolerate
gastric feedings or possibly the baby is aspirating reflux.  Not
tolerating feedings may be seen as diarrhea, vomiting, not gaining
weight, refusal to feed, refusal to feed what is needed to gain weight,
losing weight, not absorbing calories and nutrition, gassy baby, fussy
baby, abdominal distention, reflux with subsequent complications from
that as well. I am sure there may be a few more.  An NJ is placed when
the stomach or esophageal sphinters may be the cause of those issues.
With a TE fistula, it may be severe reflux/vomiting/feeding refusal and
poor weight gain/weight loss.  The feedings must be continuous, meaning
small amounts 24hrs a day because the intestines are not actually
supposed to have food directly.  The stomach acids begin the break down
of the food.  Feedings must be increased very, very slowly.  There still
needs to be a transition to stomach feedings.  I have seen our docs
allow just a few minutes of latching at breast, less than 5, on occasion
if the baby is able to tolerate but not very often.  So, the transitions
that need to happen are:  transition to gastric feedings, first
continuous then by "bolus" every three hours usually.  Bolus meaning,
one volume given at one time not continuous.  45m every three hours
would be a bolus feeding, compared to 15ml continuous tube feed.  There
may also be gastric emptying issues due to the surgical hx. There may be
worries of aspiration with reflux that could be the reason for the NJ
tube as well.  If this is the case, any liquid in the stomach may reflux
and go into the lungs.  This would be seen on and Upper G I test not a
VFSS.  Avoiding any food in the stomach would be part of the medical
plan.  If this is not resolving, one medical option would be a
fundoplication which surgically wraps the lower esophageal sphinter so
that the reflux does not occur.  If the baby is not able to orally feed,
a G tube may be placed as a temporary measure to alow the baby to grow.
Maintaining an excellent milk supply is the key when going to breast is
not an option temporarily.  that way, when they are medically safe to
feed momma's milk at the breast, it is much easier to help the baby when
there is a great supply.  

Positioning a mother and baby for latching at breast would pose a few
problems.  One would be the view of the baby during the study.  baby
needs to be in a neutral head/neck position and the machine needs to be
lateral.  Also, there are radioation exposure guidelines.  Mother would
not be able to wear the protective leaded shields.  the final issue
would be the radiologic material/we use barium in order to see the
liquid on the study.  Even with using an SNS, the barium would be too
thick to pass through and also there would be thin liquid from mom's
breast separate from the barium liquid.  So, the thin liquid could go
into the trachea but you would not see it since it was not mixed with
barium. 

Angie Kirkwood 



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