Some of you may remember my posting earlier in the summer about an infant I
saw who was having green jelly stools and was very irritable at the breast.
I received messages from Judy Knopf and Marie Davis which I did appreciate.

I saw the infant at a very casual gathering when she was six weeks old.  Whe
had gained three pounds was exclusively breastfed and when I saw her she was
very irritable at the breast and having these unusual stools.  She was well
hydrated did not look as though she were losing weight and was exclusively
breastfed.  She had been having these stools for a few days and the MD said
it was due to Mom's cold.  Imagine my horror when I learned this baby had
died one week later of dehydration.

I had discussed with the mother, dehydration and malnutrition issues,
breastfeeding management and seeking help etc.  I was supeonered to attend
the inquiry requested by the parents.  They had seen numerous physcians and
visited two hospitals. The baby died within 24 hours of being discharged
from an emergency department.  She was placed on pediatlyte for 24 hours mom
breastfed and she died, in her mothers arms in a hotel room.

This infant had had the malabsorption stools for several days before
vomiting and diarrhea started.  When I saw her I thought she was not getting
to the hind milk because of the pulling off the breast and being switched
constantly, however, at the time she was voiding adequately.  This infant
reminded me of a baby I had cared for in the NICU who had an inborn error of
metabolism, did not produce bowel enzymes that helped absorption, I don't
remember the name of it just that it was an extremely rare one.

At the inquiry the pathologist could not find any virus or bacteria that
caused the gastroenteritis, he did find some unusual fatty changes to the
liver although did not think it consistent with a genetic disorder. The
bowel was completely empty at death but had no lesions despite the infant
having bloody diarrhea. There was no mention by the pathologist of method of
feeding.  I also found out this mother had not slept for four nights and had
had no instructions on how to maintain her milk supply, but lots of advice
to feed pedialyte.

When I arrived at the courtroom the crown attorny spoke to me before putting
me on the stand. I expressed my concern that breastfeeding would not be
taken seriously by the numerous lawyers and physicians present although I
felt it played a much greater role than people realized, i.e. exclusively
breastfed infants do not get gastro, high sodium levels in declining milk
supply. She said she tool it very seriously she had been a breastfeeding
mother and saw Jack Newman who told her once you begin to breastfeed you do
not stop for any reason!

The first question she asked me on the stand was in my opinion do physicians
get enough breastfeeding education, her second question in your opinion is
pedialyte the treatment of choice for an exclusively breastfed infant. I was
armed with all the books by the experts etc.  Well just to let you know the
outcome, of the more than 50 recommendations made by the jury at the top
included more education for nurses and physicians on breastfeeding!

I am still not convinced that the baby had gastroenteritis I still suspect
an inborn error of metabolism, something rare that masked what was going on
with the baby, most nurses and physicians know the signs of dehydration.
This baby lost 1lb 9 oz in about a week prior to death.

This mother has since been in contact with me and expressed appreciation for
what I had to say at the inquiry, and the concern I showed for her baby.
She has focused on the events surrounding the last physician contact and I
do not think she wants to hear anything about congenital problems, this has
concerned me because she is expecting again in the Fall.  I have not heard
if there have been any results from the autopsy regarding metabolic
disorders but I wonder if a very rare one would sho, do you have to know
what you are looking for to identify a specific disorder? Perhaps Maryelle
would like to comment?

Susan Moxley IBCLC
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