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Subject:
From:
Pamela Morrison IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 23 Oct 1998 14:32:25 +0200
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Hi everyone, I am seeking input to assist mom of a 7 week old bf baby girl
who exhibits very laboured breathing. I have never seen anything like this
before.

Indian Mom and her SIL brought the baby in this morning.  Stated reason:
baby has breathing difficulty, and is not gaining weight well enough.
Communications not that easy, but this is what I can piece together.  Baby
was born at 38 weeks weighing 2100g, DWT 2050g, weight at 2 weeks 2300g, at
one month 2600g, and at 7 weeks 2950g. Produces 8 wets (clear urine) and 6
yellow stools (occasionally green) each 24 hours.  Mother noticed "stuffy
nose" shortly after birth and was advised to use saline drops by 2 different
paeds before she consulted a 3rd who referred to an ENT specialist.  ENT
says the problem is *not* the nose; the tube to the lungs is narrowed.  He
will do some kind of scope when the baby is bigger - or big enough to have
an anaesthetic.  Baby breathes through her nose, but breathing is *very*
laboured, with loud raspy chest noises, chest indrawing and indrawing at
throat with each inhalation. Breathing is quieter when she is asleep and
becomes very loud when she is awake and active. Mother says baby is
"colicky" in the evenings and sometimes turns blue when she cries! Describes
how baby sometimes seems to act hungry at these times but shakes head at
breast and screams (latching difficulty?)  Baby has also been diagnosed with
eczema on face and Rx hydrocortisone cream for this.

A 4th locum paed saw the baby early this week and, without observing
breastfeeding, advised mom to start formula supplements.  However, there is
no booked follow-up for weight gain or any other kind of check.
Supplementing by bottle has proved difficult as baby resists all efforts to
encourage her to take teat (bottle nipple) into her mouth, and cries.  Mom
has resorted to feeding 25 - 50ml formula once or twice per day by dropper,
which baby hates, but is forced to swallow once it is dropped into her
mouth! Confirmed on observation using EBM today - baby struggles and fights.
Questioning confirms she sometimes coughs and splutters during
force-feeding. Mom believes that the cow's milk based formula she has been
forcing is soy, which she trusts will not cause breathing
difficulties/asthma.  Mom herself dislikes cow's milk, but has a little,
also eats cheese.  Baby is also fed 20 ml water here and there on advice of
granny because the weather is hot.

Nursing exam shows that baby takes unsupported breast eagerly, mom has quick
let-down, audible and visual swallowing in bursts of 3 - 4 after which baby
pulls off breast, noisily gulps in air for 3 - 4 breaths then lunges back at
the nipple again, swallows some more etc.  This is repeated for perhaps 5
mins, baby controlling the whole thing in a very competent way.  This sounds
awful, it looks really fraught, but it works, and mom just follows along,
not forcing anything.  Baby eventually pulls completely off and slumps
totally exhausted, going very limp.  Mom lifts her upright on to her
shoulder, like a little rag doll, arms and legs all floppy, where she
gradually recovers, perks up at little, muscle tone improving, then gets
handed to auntie for a cuddle and she goes back to sleep.

I have recommended:
1. A s a p after breastfeeding express hindmilk - to maintain
drainage/supply and to provide EBM supplements.
2. Stop S*****c formula (cow's milk based) and all water and substitute EBM.
Use flat teat for EBM supplements if baby will accept, or dropper, DON'T
FORCE as this could compromise breathing.  Offer EBM only if baby wont/can't
breastfeed.
3. Offer breast *any* time baby wants to suck - use any excuse to get more
breastmilk into her. Feed in as upright a position as possible (showed
football hold, with baby sitting up). Support breast to make latching easier.
4.  Keep baby upright whenever possible, including when sleeping, offer lots
of cuddling/holding/comfort to make breathing easier and to avoid crying.
5.  Mom to eliminate all dairy from her own diet, possible sensitivity and
baby can obviously use all the help she can get in keeping her airway as
mucous-free as possible.
6.  Normal urine/stool output coupled with apparent good milk supply but poor
weight gain may indicate baby's nutritional needs are higher than normal
because of compromised breathing (like a heart defect baby, mom *thinks*
they have checked her heart, chest X-ray showed heart was not enlarged).
7.  I want to report what I have seen and recommended to the paed, but am
seeking input from my (hopefully wiser and more experienced) colleagues first!

My questions:  What is this condition called?  Is there anything else I
should be looking out for?  Anything else that I could have recommended to
the mom to make feeding easier, or increase weight gain?  Does anyone have
any similar experience they could share?  Barbara?  Anyone?  All ideas
welcome. Thanks!

Pamela Morrison

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