Hello all,

I have the mother's permission to share the following with you.  A search of
the archives yielded nothing useful on malrotation, tho a whole lot on bloody
stools -- nothing on any possible relationship between the two.

The mom is heartbroken at the thought of switching her baby on to
hypoallergenic formula, but understandably concerned about the bloody and
*extremely* frequent stools, especially in light of this baby's history of
intestinal surgery at 3 days old.  If anyone has ever dealt with a baby who
has had this type of surgery, I'd very much like to hear about your
experiences.

<< Carter was vaginal delivery 11/6/01. Other than precipitous delivery and
some heart rate decels right before birth, all was normal at birth, high
apgars. They had to suction lots of mucous; then had to suction him again a
couple of times as he was spitting up mucous in the first day and finally
pump mucous out of his stomach. All seemed well at this point. He was a bit
of a lazy nurser but otherwise he had passed meconium stools and was wetting
4 diapers a day. discharged 24 hours after delivery because all seemed well
with both mom and baby.

3 days pp mom's milk came in. Baby suddenly became lethargic, jaundiced, and
began vomiting yellow spitup. Pediatrician observed and recommended he be
seen by a surgeon. Admitted to NICU; abdominal x-rays and upper GI series
revealed obstruction.  Surgery performed that night to correct a volvulus due
to malrotation at 3 days old. No resection of bowel was required.

Baby's bowel began moving again with first BM at 9 days old, and baby was
discharged at 16 days old. Mom pumped and stored and only breastmilk was fed
to the baby in the hospital. Nursing resumed at 13 days old and was great.

After being home and stools "normalizing" from the tiny amount produced in
the hospital while getting only measured feeds, mom noticed mucous in the
stool but didn't think much of it. By 1 1/2 months, frequency of stooling was
3-5x/hour when baby was awake and several times during the night, so mom
mentioned the frequency to pediatrician. Pediatrican noted in the most recent
diaper that baby had mucousy and slightly green diarrhea as well as trace
blood in each diaper, not normal baby stool. She had stool cultures done and
advised mom to give up dairy. Mom already was on almost no dairy, so it was
not hard to cut out cheese and chocolate. Mom also eliminated red meat and
legumes; she already avoids citrus as she is allergic to citrus, and stopped
coffee and green leafy vegetables.

Cultures were positive for C. difficile infection and Flagyl was prescribed.
Baby was on a 10 day regimen, but saw no significant change or improvement
after 10 days so vancomycin was prescribed and baby was seen by pediatric gi
who observed the green mucousy stool and confirmed blood in stool; blood draw
and stool have been obtained for further testing so we don't know yet if the
C. dif is still the culprit. Upon observation the pediatric GI seemed to
think that protein intolerance or lactose intolerance or some type of
malabsorption may be happening concurrently with the infection. The baby is
growing, gaining (steady at 50th percentile), and happy and is only in
obvious distress when passing stools (and even then sometimes not). Pediatric
GI also believed the baby could have a "fast gut" brought on by the surgery
and be passing milk too quickly, or could have another type of malabsorption.

Baby has been on vancomycin for 5 days with only one change - frequency is
less. The output still looks about the same - mucous, tiny bits of visible
blood, and greenish-yellow in color.

If diarrhea hasn't resolved by next Monday, pediatric GI wants to try a
course of hypoallergenic formula. Mom is a staunch breastfeeder and doesn't
want to go down that path if not absolutely necessary. So for the experts -
are there alternatives? Could this be something else? Something else she
should eliminate in her diet? Any advice is welcome. >>

Mom is very concerned.  The babe's stooling frequency has dropped from 3 - 5
x/hr, but is still extremely frequent.  Mom's highly motivated and
succesfully breastfed her two older children.

Diane DiCarlo
LLLL
Brooklyn, NY

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