Hi everyone. You know if Vicki Hayes writes a post, it's going to be a long one. 
    Friday morning as we were driving to his older brothers' school, Lachlan sounded like he had nasal stuffiness, then like he started wheezing, then he started crying but it was a very weak, wimpy, pitiful cry and like he was having trouble breathing. I pulled the car over, he was dusky with blue lips, and I lifted his shirt to find him really retracting. I yanked him out of the car seat really forcefully, he felt floppy and limp and he was struggling to breathe, and he didn't cry or pink up or otherwise respond  when I whomped him on the back and blew in his mouth for good measure. I told the EMTs I wanted to go to Evergreen (where Jeanne and I work). Going there made this whole traumatic experience much more bearable- knowing the SCN nurses and respiratory therapist (whom the ER had called to say there's a baby coming in so they were waiting in the ER when we arrived), the awesome pediatric hospitalists (since my regular ped is down in Seattle and at a different hospital; Evergreen's on-call peds are incredible and very breastfeeding-savvy), having private SCN & NICU rooms,and all of my co-workers' support (we don't have any family here, they're all in Virginia, and Ryan is in Georgia the whole month of April)... 
    As Jeanne said, his pulse ox was in the 60s (on room air, in the ER). It was in the 80s with some o2 and albuterol. Lots of bloodwork and IV attempts (he has a lot of bruises now), IV in the scalp, chest xray, cath urine culture, EKG, nasopharyngeal swabs for pertussis, RSV, and other respiratory infections....Pulse oximetry monitor and cardiac/respiratory monitor stayed on until we were discharged Saturday afternoon. 
    We don't think he had a seizure or got truly apneic. He doesn't seem to have an infection (some still pending [pertussis], everything else negative [including RSV], but he is asymptomatic). His serum lactic acid and serum ammonia were slightly elevated (high end of normal).Chest xray and EKG normal, no murmur. Electrolytes and complete blood count all normal (he'd had a few beats of clonus and some increased tone in his legs, so ped wanted to especially check calcium, magnesium, and phosphorus). Urine culture and toxicology screen normal. His glucose was elevated in the ambulance (213) and the ER (183) but normal serum level later, so he was probably was just stressed. What I've learned from the doctor and researching Apparent Life Threatening Event online is that ~50% of the time the cause isn't determined; if it is, it's usually GI (30-50%), neuro (30%), respiratory (20%), cardiac (~%5), or endocrine/ metabolic (<5%). 
    Speaking of metabolic disorders, his birth weight was 7-5 and on admission he was 11-14 (6 weeks exactly) so I automatically assumed, well it can't be a metabolic disorder, aren't those kids usually FTT?, but ped said not necessarily, about 500 different enzymes, for each one there is the possibility of a deficiency or excess, and although he doesn't think Lachlan has one, it wouldn't be a bad idea to get a comprehensive blood and urine screening soon (Washington currently tests for 10 disorders on its newborn screening: http://www.doh.wa.gov/ehsphl/phl/newborn/disorders.htm). On a tangent, two of my and Jeanne's co-workers' children were diagnosed in the past year with inborn errors of metabolism, one was Medium-Chain Acyl co-A Dehyrdogenase (MCAD) Deficiency found from initial newborn screening, other was Heredity Fructose Intolerance diagnosed at about 20 months old (when G. finally reached 20 pounds), in which breastfeeding truly saved this now almost 2-year-old's life (because she will absolutely be in trouble if she fasts, like N/V with GI illness), and Jeanne and I have encouraged this friend (a LC) to post about it on Lactnet and write it up for the journals- she said she will once she's come to terms with it all.
   Speculation with Lachlan is that he has reflux and when something came back up while he was in the carseat, his age, position, and lack of head control kept him from responding the way an adult would when something "goes down the wrong pipe" so he might have aspirated &/or had a vasovagal response.
    I have a major OMER and I wouldn't be surprised if he does have reflux, because although he has never vomited, usually at least once a day (usually in the evening) he has an episode of being inconsolable, arching, screeching, fussy at breast, very gassy both ends, coughs, sputters, etc often during feeds, better when upright pc, etc. Because of my fire hose milk supply, I've been block feeding for about a week (usually about 6 hours). Never had any frothy green stools (now remember, this is the kid who only stooled once a week after day 4, up until March 29, when he magically started stooling at least once a day. They've been normal yellow ever since, with several "wet farts" each day too), but definitely acting like too much gas in there. I like the explanation of "lactose overload" in  http://www.breastfeeding.asn.au/bfinfo/lactose.html. My husband suggested a few weeks ago that maybe he's "allergic" (is that the right word?) to all my soy because of his sometimes extremely fussy, gassy, inconsolable behavior, and I'd started getting curious too, so to cover all my bases, I started eliminating soy today (very hard for me since I don't eat dairy but do consume about a quart of soymilk a day and some tofu every day, as well as some soy cheese/yogurt/sour cream/cream cheese &/or ice cream daily, but I will use almond milk.  
    So between OMER, possible reflux, and possible, most likely soy, "allergy" he does have issues with rapid feeding, gulping, and choking, which one article said "children who feed rapidly, cough frequently, or choke during feeding also are at increased risk" (now I think, well, duh) and "more boys than girls experience ALTEs." So when I follow up with his regular ped tomorrow, I will talk to her about Zantac. I won't be doing an upper GI series, just continue the "feeding management" I've already been doing (upright pc,...and thickening his formula of course. just kidding).  If this ALTE was GI related (from OMER, reflux, &/or something in my diet) and I use conservative management for all 3, and possibly medical management for one, I might not know exactly what worked if there is any improvement, but hopefully I won't ever experience an episode like Friday's again.
    Some random thoughts about the experience: 
    His tachypea, tachycardia, and drops in o2 saturation, all improved whenever he nursed (sats up to 99-100%).....while in the ER, I pumped while they "worked" on him (that would've been quite a picture, too bad our co-worker Marie- the photographer, wasn't there) and immediately nursed him as soon as the initial testing was done and the IV was in. A nurse seemed surprised and said "you just pumped all that milk and you still had some left to feed him!" Jeanne and I missed out on the opportunity to educate her that these are breasts, not bottles, they don't get empty. (and I *am* known for snappy comebacks)... I really appreciate the private SCN/NICU/peds rooms. I had a nice parents' bed which he and I slept in together, listening to the same CDs we listened to 6 weeks ago during his birth and after he was born (okay now I'm finally crying). links to info about our facility, there used to be a virtual tour of the SCN/NICU rooms but I can't find it in there right now
 http://www.evergreenhealthcare.org/womens/pediatrics/unit.htm ; 
http://www.evergreenhealthcare.org/womens/familycenter/intensive_care_nursery.htm
    Finally, I want to make sure that 2000+ Lactnetters know how thankful I am to Jeanne Schneider. She is my mentor anyway, and the most influential and inspiring nurse and LC I've ever met since I first decided to become a nurse and then a LC, and she once again proved herself to be a wonderful friend. Without any family here and with my husband on the other side of the country, I don't know how I would've managed without her being there at the hospital giving me moral support, keeping me sane, and running around for me (starting with meeting me at the ER as our ambulance pulled in, bringing the breastpump to me, running to Trader Joe's to buy me a bag of groceries for while I was in his hospital room, bringing me a book to read, and she and her husband drove to bring my car down to the hospital. she even offered to spend the night so I'd sleep). Also, another of our IBCLCs, Molly, who also has 3 sons :-), had Sean and Harrison spend the night at her house and then met me at the hospital with them when Lachlan was discharged. To me, the "family-centered care" at our hospital is *my co-workers at the Breastfeeding Center and Postpartum Care Centers* (which along with our status as first US BFH, Jeanne was a driving force in...mainly responsible for...a huge part of...whatever you want to call it. Don't ask her, she's too modest)
    I'd appreciate any feedback anyone has on this situation, especially if any of you have had personal experience with ALTE or mom with OMER/baby with reflux? Funny that I've been corresponding off list with a few LNers about elimination diets, overabundant milk supply, etc, but hadn't posted any of those concerns to the list because I figured I'd already gotten too long-winded on other topics (like the infrequent stooling last month). Now I have once again written a *book*!! ha ha 
   Grateful for my healthy sons (especially so for the now very pink one), 
Vicki Hayes RN IBCLC in Washington

Hall, Karen L. M.D, and Zalman, Barry D.O. Evaluation and Management of Apparent Life-Threatening Events in Children, American Family Physician, Vol. 71, Number 12, June 15, 2005 2301-2308 http://www.aafp.org/afp/20050615/2301.html

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html