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From:
cmcarnaby <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 17 Mar 1999 22:11:06 -0000
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Diane wrote:
>...31 week, 3 lb premie.  They survived
>a punitive NICU experience, toward the end of which the baby was
>gaining 10 to 30g/day.  Home at about 36 weeks and 4 1/2 lb, the baby
>immediately started gaining 60g/day, and is fully bf except for 1
>bottle of expressed milk per day containing  vitamins (apparently no
>iron).
>The baby had no stool during her first 10 days home.  As
>soon as they inserted a suppository they prompted a half-hour
>screaming session that produced an adult-finger-sized, adult-firmness
>stool>
>Apparently suppositories had been used 2-3x a week in the NICU;
>parents aren't sure why.  Their concern now is that the routine use of
>suppositories has caused physical dependence or psychological "holding
>back".  Dr has suggested bottles with karo syrup.  Any thoughts on why
>a NICU would use suppositories on a fully breastmilk-fed premie>


Although I am not a neonatologist, but instead worked as a nurse in an NICU
for over 17 years, this scenario was rare, and mostly seen in abm fed
infants.
No, it was not uncommon to see suppositories used, depending on the
treatment preference of the particular neonatologist.  We typically only
used suppositories as last resort and allowed the babies to stool on their
own.  In the extremely immature infants, say 24-26 weeks, constipation was
somewhat more freq, mainly abm fed babies.  One neonatologist used to say
that some of these babies had a "psuedo Hirshprung's"due to immature tone of
the colon.

Most likely, the baby in question is getting iron with the vitamin
preparation.  (Alot of the premies were discharged on Fe supplementation.)
How to fix the situation is puzzling since ongoing use of the suppositories
may only perpetuate the problem.  We did *not* use Karo syrup for the same
reason that honey is not given to infants.  How about stopping the vitamins
for a couple days or so and have mom 'switch nurse', to give the baby a
healthy dose of foremilk,(an induced hindmilk/foremilk imbalance so to
speak).  Try switch nursing a couple of feedings and see what happens.

The weight gain sounds adequate, so that seems to r/o milk
transfer/inadequate intake issues. Altho, this still may be a concern.  Is
10 to 30 g/day weight gain since discharge or was this the gain pattern in
the hospital?

My  question is:  Was this premie getting, or has gotten, any abm fortified
with Fe?  Because that usually caused diffuculty stooling with premies in
the unit. (Most-- 68%-- were breastfed at discharge)  I don't think I ever
saw a consitpated breastfed premie.

What is the opinion of the list's neonatologists?

Cathy Carnaby RNC, IBCLC
former NICU nurse and NICU LC

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