To: Janaki,
I would like to respond to your  question re: Tetrology of Fallot.  BW 7-4,
at 4 weeks 8-7, and at 8 weeks 8-9.  Breasfeeds well initially, then
clicking, fussing, less vigorous suck, feeds lasting an hour or more.
Babies with CHD are common at the hospital  I work at.  There can be a
change of pulmonary resistance at ~ 6 weeks of age.  This change
makes it more difficult for the baby to handle feedings , anything that
requires effort.  What might be happening during feeds is an increase in
the hypoxia the baby is experiencing.  This can result in the sucking
pattern  falling apart.  The baby may be spending time sucking, using up
calories, but gaining very little.  The CHD and general poor
nutritional/energy reserves (2 oz. gain in 4 weeks),  place this baby at
risk.  I would suggest reducing the work involved in feeding along with
increasing the caloric content of the breastmilk. This can be done by
using a supplemental feeding devise at breast, filled with higher cal brm.
To fortify the brm  you can try obtaining hind milk from the mom, or
combine 4 parts brm to 1 part concentrated formula = 24 cal per oz.
Some babies may need to go up to 27 cal.   It would be nice if the baby
could gain with the increased hind milk and supplemental system rather
than form. concentrate.  Some babies I've worked with needed tube
feeds in order to gain,  I hope the little one your helping does well.

Laura Wham, RN, IBCLC    [log in to unmask]
(801)588-3893
Primary Children's Medical Center
Salt Lake City, UT