I need your tolerant help. Please don't consider any small suggestion too
small. Maybe I forgot something:
Baby boy born 3-12-04 by C/S, BW 3005g, mother had general anesthesia (don't
ask), baby transferred to NICU at day 1 from the mother's bedside for
hypoglycemia, held in NICU until d/c on 3-15. Mother directly breastfed
infant q3hrs (per NICU protocol) effectively for 30 - 45 min. each feed.
They fed him one bottle of ABM (2 oz?) during the hours when she was still
groggy from the anesthesia. Mother was given Demerol in the hospital. Baby
had late passage of meconium, still dark at day 5, changed slowly over the
next few days to what I would consider normal stool for bf infant. He had a
bili of 8 on day 1, 10 on day 5, and 17 when he was one week old. Since
then (5 days ago) it has not been drawn by Pedi. His weight (I have not
weighed this baby, Pedi has) is either at birthweight right now or slightly
below, depending upon what hospital weight is to be believed. Mother reports
that he looks less yellow, will weigh him tomorrow and perhaps draw for a
bili. She reports that now, at day 13, he is sleepy and only feeds for
about 10 minutes before he falls back to sleep, q 2hr. His stool output has
been, in the last few days, only one per day, but since I asked her to be
sure he fed before the toddler and fed frequently, she reports two diapers
today quite full and looking yellow - mustardy. One important and possibly
significant item: she is also nursing a toddler.
This person is not exactly a paying patient, she is a coworker so much of
this information is via phone. I would consider her level of knowledge
quite high, but this to me can be a disadvantage because we sometimes miss
obvious things. My assessment (via phone) is that he simply isn't (or
wasn't) getting enough to eat. Possibly the general anesthesia has a much
longer effect than even an epidural (the effect of which Kroeger reports can
last up to 2 weeks) and he will need to be treated like any other
"inadequate weight gain" baby. There isn't a lot of information on "sleepy
baby" apart from ways to stimulate him.
Please email me privately any of you out there who see issues that I have
not highlighted, or may have missed.
Lizabeth J. Berkeley, MPH, CHES, IBCLC
Department of OB-Gyn
Texas Tech Health Sciences Center
4800 Alberta Ave.
El Paso, TX 79905
I have obtained consent from the mother involved to transmit this report to
her health care provider(s), as required by the International Board of
Lactation Consultant Examiners (IBCLE) Code of Ethics, and the International
Lactation Consultant Association (ILCA) Standards of Practice.
This report contains information which falls under the privacy sections of
the Health Insurance Portability and Accountabliity Act of 1996 (HIPAA).
When you read it, you will see personal information and details about a
mother and her baby.
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
