From: [log in to unmask]
To: [log in to unmask]
Date: Wed, 19 Jun 1996 21:15:28 +0000
Subject: infant with heart defect
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Priority: normal
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Organization: Anythink

Hello, me again

I saw a 9 week old baby today with a fairly large ventriculoseptal
defect (VSD or hole in the heart). Surgeon is planning to repair hole
at age 5-6 months. Baby is not fluid restricted and is developing
normally. Main problem is poor weight gain.
Baby weighed 8lb ish at birth (having to convert from grams here) and
has gained about 18 ounces since birth. She is certainly not tiny,
but growth seems to be slower as she gets older. Length and head
circumference are above 50%.
At the breast, she struggles with a strong MER and gulps/gasps, feeds
for about 5 mins then lets go. She gets very distressed after feeds,
?? gas from all that gulping?? but won't go back to breast. Mother
says she will often refuse breast outright, even if she hasn't fed
for several hours. If offered a bottle of ABM, she will drink it but
can still be unsettled afterwards. She was a very jumpy baby when
newborn, not so much now.
My main concern is how to get this baby to gain weight. I feel the
problem is partly due to the heart defect and higher metabolic needs,
but the brief feeds are probably not allowing her to really drain the
breast. Mother has tried pumping with a hand pump but has never got
much (2 ounces max both breasts), and doesn't feel she can do this to
supplement the baby. Baby still gasps and gulps if fed 'uphill' on
mothers chest, and goes crazy and refuses breast if she has to wait
too long for a feed or if she's taken off the breast after the MER to
allow the milk flow to slow down.

Sorry to be a bit longwinded. Any suggestions or ideas?. I have saved
some previous postings on infants with VSD, but they were also prem
and fluid restricted.
I look forward to some words of wisdom for this very determined
mother.

Fiona Coombes
doctor and IBCLC
Perth Western Australia
where we are getting thunder storms and wonderful rain at last!!
Fiona Coombes MBBS IBCLC               [log in to unmask]
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Lactation Consultant, Family Physician
Perth Western Australia