Hi "Gentle Spirit"
I can "hear" the panic in mother's email. First, reassure her that her baby
can definitely still learn to breastfeed and she is not missing a window of
opportunity; that her milk continues to be the best for her baby. Remind her
that with a very early baby like hers, there will very likely be some steps
forward and some steps backward along the way. With NEC there is typically a
bad septic look to the baby, usually a typical pattern is seen on the xray,
the blood count may show infection, the infant often has apnea, along with
the blood in stool, and usually tummy dilation. As she realizes, NEC can be
very serious, and while it is appropriate to question what is going on and
connect the prior infant's dairy allergy, it is important that the nicu
staff treat this aggressively. The baby will be fed IV with all the
essential nutrients, altho the baby will likely not gain weight during that
time, and might even lose some ounces. If the NEC is not treated
appropriately (if that is what it is) it will be much much harder to feed
the baby again and in the long run. Just keep her pumping and visiting the
baby.
It is difficult to deal with a dairy allergy when using the fortifier, and
also just the digestibility of the fortifier can be an issue. However, it is
also important for very early babies to have the extra protein and minerals
that they otherwise cannot get by breastmilk alone. So she should definitely
speak to the doctor about her concerns and about what other options might be
available. Allergy can show up with other changes in the blood tests, but
usually is not so profound as the NEC looks. I'm not even sure if very early
babies can even mount a big allergy antibody response, we typically don't
see that in premies. I would recommend that mother eliminate dairy all the
way, if it was an issue before, and at least to minimize the load on the
baby so that the baby could better tolerate the fortifier while it is still
needed. Sometimes just the decrease in overall dairy exposure will help
alot. I hope the baby is well soon. Give mom my best.
Laurie Wheeler RN MN IBCLC - former NICU nurse
Mississippi USA

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