Hi all, I'm seeking your collective experience again. Two days ago a former
client phoned me just before she was due to book into the hospital to have
an elective C/Sec. Her first baby, a girl, is 16 months old, breastfed only
9 weeks, because mom suffered a bacterial nipple infection and recurrent
mastitis and she elected to suppress lactation. This baby was a boy, and
she booked an appointment for the morning after the C/Sec to review
positioning etc in the hope of getting everything absolutely "right" from
the beginning this time.
When I arrived at the hospital the Sister in Charge told me that the baby
had been born with multiple deformities. The parents are just devastated,
the family arrived yesterday, everyone was crying. Baby was well-wrapped
when I saw him, and all I could see was the little face, small eyes,
cyanotic because he had just vomited, vomitus coming through the nose, and
jaundiced. The mother tells me that he has a cleft at the back of the
palate, webbed neck, one arm ends at the elbow, the other hand has a thumb
and two fingers, and he has club feet. The paediatrician suspects some kind
of inherited syndrome and is looking up his books, expected that the baby
might not survive the first 24 hours, but I think that he will. The Sister
told me the paediatrician has ordered that the baby *not* be resuscitated if
he should need this. Feeding instructions were that mom could try the baby
at the breast, and that he might be able to breastfeed, in the meantime he
should be offered glucose water.
What to do? Mom broke down when I walked in, lamenting "I don't know how I
am ever going to be able to cope with this" etc. so I provided long hugs
firstly, then kinda introduced myself to the baby. Because he was wrapped
up it was not difficult. I tried my best to focus on the baby, rather than
the abnormalities, and explained how the parents could tip him over if he
vomited and help him breathe afterwards etc., and told them that many babies
are mucousy in the first 24 - 48 hours, trying to keep them aware of the
normal things. The rooting reflex was very depressed, but he was making
little mouth movements and tongue movements, but obviously was *not*
interested in breastfeeding at this time.
So, in the absence of firm feeding instructions, I got the mom expressing
into a spoon (fortunately she has a really good supply of colostrum) and
showed her how to spoonfeed the little guy one or two drops at a time and he
managed beautifully. I suggested, in view of the large Qx of colostrum,
that she should feed this in preference to glucose water, to maintain blood
sugar, 2.5 ml, wait two hours, then 5 ml, wait two hours, then 10 ml every 2
hours for the rest of the day, (based on 60ml/kg/day for the first 24 hours,
he's only 2.2 kg) increasing if the baby seemed to want more and offering
the breast if he showed rooting, holding baby at a 45 degree angle to avoid
milk running into the palate. After we'd finished with this, she picked him
up and held him close, I could have wept.
We've booked a follow-up tomorrow morning and if it seems appropriate I plan
to cover positioning/latching and seeing if the baby can breastfeed.
So, I'm looking for advice/cautions from anyone who might have worked with a
similar situation. From this description can anyone hazard a guess at what
this syndrome might be? And the prognosis? Mom has *not* taken any meds at
all during pregnancy, and has *not* had a viral infection, as far as she knows.
Thanks if anyone has any ideas!
Pamela Morrison IBCLC, Zimbabwe
mailto:[log in to unmask]
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
