From: [log in to unmask] To: [log in to unmask] Date: Wed, 19 Jun 1996 21:15:28 +0000 Subject: infant with heart defect Reply-to: [log in to unmask] Priority: normal X-Mailer: Pegasus Mail for Windows (v2.23) & WPEGWAF v0.7 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