Dear Sharon,

Another great case you describe that raises many questions!!!

First let us look at the history you gave us.  The baby seems to be term
and well grown (7 13 at birth).  The spells he was having certainly are
compatible with reflux and posssible aspiration.  I doubt in view of term
baby that this is related to immature respiratory center (or central
apnea) as it is in premies.  One red flag is that this baby did not
regain BWt until 8 weeks.  He was sleepy and nursing poorly.  Altough he
may have been influenced by the meds, poor feeding can stem from many
other reasons.  A few I would think about are:1. Poor technique (pos,
latch..) leading to poor intake and decrease in mom's supply. 2.Baby not
growing because of Reflux, in this case prob secondary to imparing his
breathing.  3. Excess losses due to reflux.

It seems though that after the baby was treated and supplements
introduced this baby did well.  According to the weights you gave, his
speed of growth has been normal from 8 weeks to 5 months,  I know, he is
below the 5 percentile.  Remember that 5% of babies are normal and below
the 5 percentile.  Usually we do not worry if the velocity is normal as
in this child.

To answer the question about medication.  One I wonder why this baby is
event on theophylline. Usually used for central apnea in immature babies
and not for secondary obtructive apnea from reflux.  Usually the doses
used are very small (about 1/3 of what you would use in athsma).  Many
physicians think that theophylline increases metabolic needs of infants
and overfeed  them.  I studied this question in adult and infant rats
during my fellowship.  We looked at 24 hour metabolic rates in rats
before and during theophyllin.  We gave it for 3 days.  There was an
increase in metabolic rate primarily due to increased activity but not to
basal metabolic rate of about 20%.  Interestingly, this increase was more
marked on the first day and decreased to no significance on the 3d day.
We therefore felt that the rats adapted to the effects just like coffee
drinkers adapt and feel very little effect after using caffeine for a
while.

Hopefully this will help you in answering this mom's questions.  One more
point is that this baby may have some underlying athsma problems.  I
remember one patient I had who didnt nurse well and lost weight around 2
months, without a good explanation.  After intervention, using sns and
increasing mom's milk supply, she never quite caught up but has been
groing at normal rate along 5th percentile.  So we were pleased.  Mom is
a thin person and baby looked like her.  Between 6 months and 1 year she
developped a chronic cough and runny nose.  Was worked up by
pulmonologist and reflux was ruled out.  Never wheezed.  Finally, started
empirically on athsma meds and picked up quite a bit on her wt.  The
kiker is now she is a butterball but another factor is that this 2 year
old nursing toddler just had a baby brother and is going to town on
additional nursing!!!! So who knows exactly what did it!!!

Good luck

Maryelle