Babies with cardiac malformations generally grow better when breastfed
rather than bottle fed because they have an easier time maintaining
blood oxygenation during breastfeeding. This said, the baby may require
shorter more frequent feeds.
There are subtle signs of cardiac disorders during feeding. Baby's
respiratory rate will generally increase while he tires, and his
swallowing may become sloppier. This is because the hypopharynx (the
area where the airway and foodway cross, the center of the x shape they
make) is what Dr. Julie Cichero calls a "biological timeshare", only
food or air can occupy it at any one moment. When milk is there, the
baby must suppress his breathing long enough to swallow, or he risks
getting the milk into the airway. When a baby has to work harder to get
oxygen around his body, he has to breathe faster or harder. This leaves
less openings in the timeshare schedule for milk to use the hypopharynx,
or if the milk flows down anyway, the baby will not have enough spaces
for the breaths he needs, and he may start to breathe even though there
is still fluid in the airway, like someone whose head is held underwater.
I imagine this baby had some sort of palliative shunt procedure done in
the hospital, or at least is on prostaglandins to keep his ductus
arteriosus open. If he is doing this well without either of the above
procedures, he probably has a large hole between the ventricles of the
heart as well. If this is the case, he will need more calories than
usual to maintain growth. He will require closer followup.
Danger signs include wet breathing sounds after feeding (milk went down
the wrong pipe), a loud purring sound during breathing (the lungs are
getting affected by high pressure in their blood vessels), and failure
to feed. If the work of getting oxygen gets very difficult, the baby may
not have time for eating, and should be seen by the specialist right away.
Best with helping this mom.
Catherine Watson Genna, IBCLC NYC
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