Also, Lasix has appetite-suppressant effects in young children, so give it
after a feeding, rather than before.

See also excellent article on breastfeeding babies with cardiac problems
in this month's JHL that just arrived. (Not a study in the formal sense,
but has several good suggestions of how to handle.)

From personal experience, the cardiologist's fixation on wieght gain
probably has to do with timing of surgery.  Baby has to be "XX kg" in
order to use cardiopulmonary bypass for surgery, which is easier for
surgeon and safer for baby than using hypothermic cardiac standstill.
Sooner baby has surgery to correct AV canal, less cardiac and pulmonary
problems in future.  We did a little of everything to get Janette to gain
weight fast enough:  compression, supplementing with high-cal formula in
SNS (which she didn't tolerate), supplementing with hindmilk in SNS,
started solids at 4 mos instead of waiting until 6, adding high-cal stuff
to the cereal, etc.  Even pumped and fed to her in bottle without feeding
at breast for a time to "prove" to docs that she was "getting enough".
Remember, the caloric requirements of a baby with a cardiac defect can be
as much as 1.5 to 2 times normal.

Becky Saenz, MD
Assistant Professor, with articles on both Down syndrome and CHD coming
out soon in American Family Physician! (Yes, I strongly recommend
breastfeeding in both!)
University of MS Medical Center
Department of Family Medicine
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