I did pull the first article I mentioned from Am. J. Med.  A nice review of
Lyme in children;part of a special issue symposium on Lyme.  (Also found
some Lyme info on the www-support groups, medical info, etc.)  This
article says transmission through breastmilk has never been documented
and that no specific syndrome of "congenital Lyme" has been documented.
There are no definite cases of Lyme contacted from mother before birth,
although the spirochete that causes it has been isolated from some
stillborn and aborted fetuses without any evidence that it contributed or
caused any anomalies.


I'd like to share something with you all to see if you have any comments
or suggestions.  I recently was privileged to attend the birth of two
excited, committed, intelligent parents.  This is  a *very special* baby
as they had assumed for medical reasons they could not get pregnant.
Mom had breast reduction mammoplasty
many years ago and also has inverted nipples.  She wore shells throughout
pregnancy, and had prenatal visits with the LC to prepare for probably
supplementing at breast.  Baby was 9 lb 4 oz at birth.  They tried
valiantly to avoid bottles, just feed at breast, pumped and finger fed,
etc., etc. Managing the inverted nipples and the at-breast feeding tube
was too hard for them to manage without extra help (not feasible after
discharge).  After 4 days, baby was hungry (but not dehydrated), mom and
dad were absolutely exhausted and unhappy with each other and unhappy
with the baby.  They have chosen not to continue their attempts.  Mom was
only getting 1/2 oz with double pump by day 5, mostly from one side, and
was getting very sore.  They are now bottle feeding and *much* happier.
Mom is interested in trying to have baby spend some time at breast
without any pressure to nurse (once they all recover for a few days,
anyway).  She does have some engorgement despite not much out (presumably
because ducts were cut at time of surgery).  Has anyone had a client who
did this successfully?  Mom is concerned about stimulation leading to
persistent engorgement, etc., but my understanding is that if it's not
emptied it will stop producing.  Any thoughts or encouraging words?

Re: PKU.  We do it before discharge then repeat it at the first
well-child check.  Probably only necessary to do it at the office visit,
but doing it both ways means everyone gets it done at least once (we
check for things besides PKU--hypothyroidism, etc.) and most babies get
an accurate PKU after 72 hours of age.  Babies who miss that appointment
still have one done in hospital, which has a chance of picking up severe
PKU problems, I think.

--
Anne Montgomery, M.D.
[log in to unmask]
St.Peter Hospital Family Practice Residency
Olympia, WA