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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html