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From:
Theresa Johnson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 1 Dec 2003 14:06:44 -0800
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Just an FYI and viewpoint,

My baby was a c/s baby and had a tachy resp count of about 70+.  I am a nursery/labor and delivery nurse and so knew what I was counting and what I was looking for.  When I let my pediatrician (a very good clinician and well respected) know about the RR when he came in the next day (baby was vigorous, good nurser, poss IUGR or SGA due to my high blood pressure, 5lb-8oz at birth (40 weeks) and I was on aldomet, 1993), he just smiled at me and said, "Theresa, your baby is healthy and well."  At the time I guess thats all I needed to hear.  He looked at the whole clinical picture.  I am sure he was thinking it was TTN without doing alot of interventions to prove it.  My daughter went home tachypnic but was occasionally having resp rate down to 50-60 at 48 hours.  Lungs clear and no color changes with feeding etc.

She went on to gain 15 ounces from discharge weight in 1 week.  Of course the ped was very pleased as was I.  And her resp rate was at normal at the 1 week.  She slept in our bed, and was fed on demand.  We didnt even put up a crib or basinett for her (she was our 3rd)  Just a Longaberger ( very nice!) laundry basket that I would carry to the next room with me if I needed to put her down.  Otherwise she was in my sling.

Who knows what her chest xray showed, she was being treated from a wellness viewpoint.  She was coordinated in her suck/ swallow and had an intact gag reflex etc.  She never coughed etc when feeding and of course acted well.  So I would guess the risk of aspiration was very small even at 70-78 breaths per minute.

By the way, at the time (1993) at this hospital it was our policy to always tube fed infants with RR over 60 for the same reasons you are finding they insist on it at your hospital.  I think that my doctor was looking at the clinical picture to guide his diagnosis and his course of treatment.  But nowdays (2003), I am at a different hospital on the other coast (Florida) and here we would probably let the ped know about the tachypnea and let the baby breastfeed and observe feeding in nursery with pulse oximeter EKG monitor on during feed and watch for desaturation/bradycardia that was sustained.  We all know there is some short desat that the baby will have - pause for - and catch up on breathing and then proceed to continue to nurse while bringing the sat level up.  If after several good feeds with this data I would think you could show the infant is not at a high risk for aspiration.   We would probably do the xray thing etc also and maybe even saline lock for meds etc.  But the
 breastfeeding would be supported.

And of course a physiologic fluid, such as breastmilk, would be the fluid of choice for feeding for anyone suspected of any feeding difficulties, even given in a tube.

Sheeesh......

I wish I could work with someone as wonderful and as well informed as you, Dr. Jay!!  Let us know how this ultimately turns out.

Interesting,
Theresa









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