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Date: | Mon, 16 Nov 2009 12:43:52 -0500 |
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Any time an infant has a cardiac or respiratory issue that interferes
with good oxygenation, feeding and particularly swallowing can be
stressed. Babies need more oxygen during feeding to support the work of
feeding (feeding is aerobic exercise). If the baby has difficulty
meeting this oxygen need, there may not be sufficient energy to feed well.
Wolff Parkinson White syndrome is caused by the existence of extra
tissue that passes signals to cause the ventricles to beat in addition
to the atrioventricular node (AV node). The accessory pathway may
conduct signals faster than the av node, or it may have a shorter
refractory period (it may "recharge" faster). This can cause the
ventricles (the large chambers of the heart) to beat much faster than is
healthy, and often before they are optimally filled with blood. The
result is usually low blood pressure, and low perfusion (ability of
blood to get to all the cells to oxygenate them). This can cause
exhaustion and dizziness in the baby, which also makes it difficult to feed.
Babies often compensate for cardiac inefficiency by breathing harder
(increased effort of respiration) or faster (increased respiratory
rate). Babies must close their airway for a fraction of a second in
order to swallow. You can see how increasing the amount of breathing the
baby needs to do reduces the time available for swallowing; and that
swallowing will reduce the amount of breathing the baby is able to do.
Healthy babies are well able to tolerate the respiratory pauses of
breastfeeding, but ill babies given the choice between food and oxygen
choose oxygen!
Now, when an ill baby is trying to sneak in a very quick swallow so he
can go breathe again, the swallow is often stressed and imperfect. Lots
of things need to move in order to swallow safely, and this coordination
is harder when you are trying to do it in a hurry. So rapid heart and
respiratory rates also degrade skillful swallowing.
Ways to support babies with these issues include ultra frequent short
breast feeds (giving baby unlimited access to the breast by skin to skin
carrying (slings work well to support the baby), having mom recline
during feeding so baby is prone and "uphill" and can allow milk to fall
out of his mouth as needed, and making sure mom does not hold baby's
head to the breast so he can let go in mid flow. A little more head
extension than usual can also make breathing easier (like people throw
their head back when they chug a drink).
Bottles are unlikely to be easier for the baby. Some babies with cardiac
issues do better with supplementary oxygen during feedings (by nasal
cannula).
And they often get better at coordinating swallowing and breathing with
practice, even if their physical condition remains challenging.
Catherine Watson Genna, BS, IBCLC NYC
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