I just came from a home visit to two week old with what the parents  referred 
to as "Two to One Heartblock."  Baby was delivered early via  C-section as 
diagnosis was made in utero.  Baby was supplemented with  bottle in hospital, 
post breast feeds, as well as at home.  Mother was  given nipple shields in 
hospital but she has just discontinued using them.  Usually, one to two ounces was 
given to baby after she frets at the  breast.  Mother presents with two 
cracked and sore nipples.  Baby is  on oral Hydrocortizone.  Mother is on 
Dexamethazone which she is weaning  off of, but was on during pregnancy given fetus 
diagnosis.  Milk supply was  fair, but baby was so unwilling to work at the 
breast, that I am using SNS to  increase flow to baby more quickly as well as to 
convince parents to rely on  bottles less.  Also, gave mother Symphony to start 
pumping at least four  times a day beginning tomw.  Each feed takes over an 
hour  currently.  Baby has not regained birth weight at two weeks old.  Baby 
does not suck vigorously and does not stay at breast for long before  she shuts 
down and falls asleep.  I am unsure of the tolerance of baby  given this 
diagnosis and came away feeling worried and concerned for any stress  on the baby.  
I will contact HCP tomorrow for information but wondered if  any of you have 
worked with babies with this Heartblock diagnosis.  Thanks,  Ann Conlon-Smith, 
IBCLC, LLLL
 

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