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Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 27 Apr 1999 18:37:55 -0400
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I hoping for suggestions for 'the next time'
???  How can the suck 'reflex' be stimulated in a prolonged sleepy baby
???  What might have caused the prolonged depession in this baby

G1P0, term, negative history for drug/alcohol use in pregnancy. prenatal
course uneventful (no GDM) neg GBS.  12 hour labor.  Medications:  Stadol -
total dose - 2 mg, last dose 5 hours pre delivery.  Benadry 25mg IV
(reported that fly-in doc says this will potentiate stadol and relax mom) -
4 hours pre delivery.  Intrathecal with fentanyl and marcaine 'light dose'
(benadry didn't work) 3 hours pre delivery.  Mec stained 2 hours pre
delivery.  Scalp eletrode traced irregular FHT prior to delivery.  20 min
second stage.  Vag del 4500+ baby.

Apgars 8 & 9, (-) mec in lungs, gastric suction - mucous/blood.  Skin to
skin within 30 minutes.  Offered breast, nuzzled only, no latch.  EKG at 1
hour showed PAC's.  BS at 1 hour=58.  BS at 2 hours=52.  Mec stool, no void.

4 hours - Assessment:  VS WNL including B/P and SAO2, color pink/red, HR
without irregularity heard.  Sleepy, breast offered, no interest.
Reassured mom, normal pattern after birth.

8 hours - Assessment unchanged, Small void. BS=50.  weak suck.  Mom
committed to BF.  Normal anatomy of breast & nipples. sleepy, no interest in
breast. Reassured mom and instructed her on using her pinkie to stimulate
suck reflex.

12 hours - Large amounts x2 of mucous with old blood spit up.  No void. Pedi
initiated a call, concerned LGA and lack of fluid/nourishment.  Considering
supplement.  Reviewed reassuring BS and lack of symptoms re: hypoglycemic -
except for sleepiness.  Requested opportunity to cup feed glucose water
instead of bottle feeding formula.  Reluctant but agreed.  Gastric suction
done 20cc return of mucous and old blood.  Reacted to stimuli, not
vigorously.   BF attempt.  Mom using good technique and positions.  Baby
sleepy, no interest, opens mouth but does not attempt to root or latch.
30cc 5% glucose given by cup.  BS=64

16 hours - report given, weight loss of 115gms.  encouraged use of cup if
pedi wants 'supplements'  Rationale shared.

28 hours - report received.  Total of 50cc/12hr  formula via nipple.  BF
attempts x3 without interest.  Nipple shield tried, report of minimal effort
from babe.

29 hours - suck assessment.  Strong suck with roof stim.  When lip/tongue
stimulated, no response!  No rooting reflex seen.  BF attempts without
effort of baby.  50 cc formula (pedi order) via cup.  Mom set up with
electric pump.  20 cc colostrum obtained.

33 hours - Pedi initiated a call to check on baby.  Considering lab/tests.
Reviewed lack of voiding since 8 hours and increasing alertness.  Baby awake
but still not vigorous, some rooting, no attempts to latch.  20cc colostrum
given via cup by mom.  (pedi order to supplement but not how much or what).
Pumped 15cc colostrum.

37 hours - Awake, vigorous, crying, rooting (YEAH!!)  To breast, latched
5min on Left and 2 on right.  Colostrum via cup by mom.

40 hours - Report given.  Mom still committed to BF and committed to using a
cup for any future supplements.  She was encouraged to pump only after the
baby finished.

I have been a LD/PP nurse for 10 years and intrathecals with
Fentenyl/Marcaine have been used repeatedly.  I have never seen such a
prolonged 'depression' in the baby.  I have also never seen a baby who did
not respond to lip/tongue stimulation, even if weakly.
Could the use of Benadryl in combination with the other drugs AND lack of
voiding (if meds are metabolized in liver and excreted in kidneys) caused
this prolonged sleepiness?
Did the baby wake up on his own or did the colostrum have something to do
with it?
I will follow-up with this patient over the next 6-8 weeks to see how BF is
going and use this case for review.  Perhaps I can convince other staff -
including pedi - that pumping and cup feeding is more beneficial than
nipples and formula!!

Any suggestions would be appreciated.
Thanks   Marley, RNC

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