This question is for anyone out there who could offer suggestions for
supporting breastfeeding in the following situation:
3#6oz infant boy born at 35 weeks gestation who has a large ventricular
septal defect. The current plan is to perform surgery to correct this
when the baby weighs 10 pounds.

Mother has been using an electric breast pump since delivery and is
producing large volumes of milk. The baby is tiny and the mother's
breasts are "huge" (per report of staff who are working with her). The
baby has never latched on; attempts produce screaming and arching. Baby's
physicians feel that breastfeeding is too stressful in light of this
baby's behavior at breast. Breastfeeding is also being ruled out because
this baby is on a restricted fluid intake due to cardiac situation and
there is also a question of possible kidney anomaly. The kidney status is
being evaluated-nothing positive as of now.

The N-ICU nurse who is caring for this baby asked for my thoughts which
are: have the mom hand express or pump, allow the milk to separate and
gavage the baby whatever amount is ordered while he cuddles at breast.
Hopefully, he will lick or play or just plain relax and develop good
feelings about being at breast with no required behaviors (i.e. feeding
or latching on) unless that's his agenda. I also suggested that mom
express drops of colostrum for his sensory pleasure if he exhibits any
oral cues.

I have minimal experience with special needs babies. If anyone of you
lactation angels could comment or make further suggestions, we would
really appreciate your input. Thanks!

Amy Mueller, BSN, RN, IBCLC
Traverse City
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