To Diane, R/T malrotation surgery and blood in the stools. Has the
physician considered a "slow bleed" where the surgery took place? Hate
to suggest anything but breast milk, but a short course of
hypoallergenic formula would either rule out or in that possibility.
Cheryl Muller, RNC. IBCLC

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Subject: LACTNET Digest - 28 Jan 2002 - Special issue (#2002-123)

10. malrotation surgery -- elimination problems

.
------------------------------

Date:    Mon, 28 Jan 2002 15:05:50 EST
From:    Diane DiCarlo <[log in to unmask]>
Subject: malrotation surgery -- elimination problems

Hello all,

I have the mother's permission to share the following with you.  A
search of
the archives yielded nothing useful on malrotation, tho a whole lot on
bloody
stools -- nothing on any possible relationship between the two.

The mom is heartbroken at the thought of switching her baby on to
hypoallergenic formula, but understandably concerned about the bloody
and
*extremely* frequent stools, especially in light of this baby's history
of
intestinal surgery at 3 days old.  If anyone has ever dealt with a baby
who
has had this type of surgery, I'd very much like to hear about your
experiences.

<< Carter was vaginal delivery 11/6/01. Other than precipitous delivery
and
some heart rate decels right before birth, all was normal at birth, high
apgars. They had to suction lots of mucous; then had to suction him
again a
couple of times as he was spitting up mucous in the first day and
finally
pump mucous out of his stomach. All seemed well at this point. He was a
bit
of a lazy nurser but otherwise he had passed meconium stools and was
wetting
4 diapers a day. discharged 24 hours after delivery because all seemed
well
with both mom and baby.

3 days pp mom's milk came in. Baby suddenly became lethargic, jaundiced,
and
began vomiting yellow spitup. Pediatrician observed and recommended he
be
seen by a surgeon. Admitted to NICU; abdominal x-rays and upper GI
series
revealed obstruction.  Surgery performed that night to correct a
volvulus due
to malrotation at 3 days old. No resection of bowel was required.

Baby's bowel began moving again with first BM at 9 days old, and baby
was
discharged at 16 days old. Mom pumped and stored and only breastmilk was
fed
to the baby in the hospital. Nursing resumed at 13 days old and was
great.

After being home and stools "normalizing" from the tiny amount produced
in
the hospital while getting only measured feeds, mom noticed mucous in
the
stool but didn't think much of it. By 1 1/2 months, frequency of
stooling was
3-5x/hour when baby was awake and several times during the night, so mom
mentioned the frequency to pediatrician. Pediatrican noted in the most
recent
diaper that baby had mucousy and slightly green diarrhea as well as
trace
blood in each diaper, not normal baby stool. She had stool cultures done
and
advised mom to give up dairy. Mom already was on almost no dairy, so it
was
not hard to cut out cheese and chocolate. Mom also eliminated red meat
and
legumes; she already avoids citrus as she is allergic to citrus, and
stopped
coffee and green leafy vegetables.

Cultures were positive for C. difficile infection and Flagyl was
prescribed.
Baby was on a 10 day regimen, but saw no significant change or
improvement
after 10 days so vancomycin was prescribed and baby was seen by
pediatric gi
who observed the green mucousy stool and confirmed blood in stool; blood
draw
and stool have been obtained for further testing so we don't know yet if
the
C. dif is still the culprit. Upon observation the pediatric GI seemed to
think that protein intolerance or lactose intolerance or some type of
malabsorption may be happening concurrently with the infection. The baby
is
growing, gaining (steady at 50th percentile), and happy and is only in
obvious distress when passing stools (and even then sometimes not).
Pediatric
GI also believed the baby could have a "fast gut" brought on by the
surgery
and be passing milk too quickly, or could have another type of
malabsorption.

Baby has been on vancomycin for 5 days with only one change - frequency
is
less. The output still looks about the same - mucous, tiny bits of
visible
blood, and greenish-yellow in color.

If diarrhea hasn't resolved by next Monday, pediatric GI wants to try a
course of hypoallergenic formula. Mom is a staunch breastfeeder and
doesn't
want to go down that path if not absolutely necessary. So for the
experts -
are there alternatives? Could this be something else? Something else she
should eliminate in her diet? Any advice is welcome. >>

Mom is very concerned.  The babe's stooling frequency has dropped from 3
- 5
x/hr, but is still extremely frequent.  Mom's highly motivated and
succesfully breastfed her two older children.

Diane DiCarlo
LLLL
Brooklyn, NY

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End of LACTNET Digest - 28 Jan 2002 - Special issue (#2002-123)
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