Hi all,
Just wanted some input from those of you in the hospital setting.  Today I
worked with (and fretted over) a baby girl > 24 hours old.  VERY sleepy, not
rousing to stimulation however vigorous, not latching.  Mom very
flat-nippled, stated not usually that bad (more areolar edema secondary to
epidural, I believe).  We worked for several 30 to 45 min. sessions without
ever achieving latch, much less audible swallowing.  I attempted a
finger/syringe feed with D5W, only getting 6cc into her!  Very disorganized
suck/swallow, much gagging on mucous (probably full of mucous, part of the
problem).  Mom had claimed a good breastfeeding early that morning, but I had
great doubts whether the baby had done any nursing at all.  If not, that
meant she had had nothing to eat since birth.  After fighting off the
bottle-toting nursery staff, I attempted a finger/syringe feed with abm at
the 20 hours old point.  What I got was very tight jaws (which I tend to see
in caloric deprivation), one or two sucks and extensive tongue fluttering,
pushing most of the abm out of her mouth, and a half-hearted swallow!  After
20 mins. of this, I put a nipple on the bottle (red premie) which was too
much for her, so changed to orthadontic-type, which seemed to help her.  It
took another 45 mins to get 30 cc into her!  Two hours later, though, this
little girl was wide awake and rooting vigorously.  Latch is still a problem
but one we're continuing to work on (shells, stimulation of nipple, etc.)

This is the most drastic effects I've seen in awhile.  I'm wondering if it
could be mainly caloric dep combined with a new, sleepy baby??  Do you who
see little ones under 24-36 hours old run into this situation?  How about the
tongue flutter?  This child sustained that flutter longer than I've ever seen
before!!  Input will be greatly appreciated.

Kathy Parkes, RN, IBCLC
San Antonio, TX