Babies with congenital heart defects (CHD) have a higher caloric need to
gain weight. Because of the hole in the heart, whether it's between upper
chambers (atrial septal defect, ASD) or lower chambers (ventricular septal
defect, VSD), the blood preferentially flows to the lungs. This keeps the
baby on the brink of congestive heart failure (CHF) most of the time, which
is the reason to limit fluid intake. Since the blood is going where it
shouldn't, it's not going where it should and the heart has to work harder
to get blood everywhere else (brain, liver, kidneys, etc.) This is the
reason for the increased caloric intake. To make matters worse, these
babies are often treated with Lasix (to get rid of excess fluid) and
Digoxin and/or Captopril (to stregthen the heart muscle), both of which
have appetite suppression as a side effect in children. There are studies
showing that oxygen level in baby's blood drops less with breastfeeding
than bottle feeding because baby doesn't have to hold his breath to
breastfeed. However, these babies often get extremely tired with any
exertion (think of an elderly lady with heart failure that can't walk very
far without getting short of breath). Feeding (any method) is like a
workout for them. Add to all that the pressure to grow the baby big enough
to do corrective surgery by the time he's six to eight months old, so that
permanent lung damage doesn't occur as a result of all the extra blood
going through them . . . It's not an easy situation to deal with. And, mom
may have been surprised by the fact that baby has a CHD, so very
emotionally upset, to boot. (A set-up for inhibited MER.)
All this to say that SNS is the way to go. May need "high-cal" supplement
in it, either fractionated hindmilk with fat content raised like Paula
Meier does with her premies, or a high-cal artificial supplement. Yes,
this is one of the few instances in which formula may truly be "medically
indicated". May also need MER enhancement, etc., even oxytocin nasal spray.
Hope this helps,
Becky Saenz, MD, IBCLC
Assistant Professor of Family Medicine
mother of a baby with CHD, whom I breastfed for 19 months
At 11:41 AM 11/18/99 -0700, you wrote:
>I need your collective experiences! I have been counselling a mother who
>has been told her baby has a "hole" between two chambers of his heart. She
>has given him (2 wks old now) expressed breastmilk exclusively. She took
>him home yesterday (on 02) and wants to breastfeed directly. Her doc. told
>her he has to be fluid restricted, but supplemented to increase calories.
>When she asked me I told her, frankly, this was beyond my level of
>expertise (it really is).
>
>But, I thought I detected a contradiction in the advise. Why would you
>supplement if the baby needed to be fluid restricted? I'm sure its just my
>lack of training in cardiology, so would someone please explain this to me?
>I hope she will be able to breastfeed naturally because I have been so
>impressed with her motivation and assertiveness.
>Help!
>
>L.J. Berkeley, MPH, CHES
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>
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