Sunday, December 12, 2010

Steppin' on down to the Cardiac Floor

After C broke the pacer wire it was decided he really didn't need it anyway.  The wires were removed and about 10 minutes later so was his chest drain.  Almost as soon as the pacer wires were removed the PVCs stopped.  It seems they were somewhat irritating for his heart.  Removing the chest drain allowed a little bit of air into his chest cavity causing a slight pneumothroax.  The doctors were all set to release us today, but one of the residents didn't agree.  She wants to wait until Monday when she can talk to GI to confirm how his remaining reflux issues should be handled and wants me to have a consult with lactation for eventual breast feeding.

They aren't allowing me to breast feed right now because they want to fortify his feedings still.  I'm a bit frustrated by this.  Without fortification, C gained about 30 grams a day.  But because his volumes weren't what they expected for weight gain if the breast milk had the average of 20 kCal per feeding, they decided he wasn't getting enough calories.  I've expressed my confusion over this given his weight gain both in the 2 days since he started eating again (and his intake is up significantly from that point) and his weight gain prior to the repair when we were in for feeding issues.  In both instances he's not taking their goal volumes, but he's gaining weight and isn't dehydrated.  She carefully explained to me (again) that breast milk has 20 kCal.  I interjected the word average at this point, because it isn't that every woman's breast milk has 20 kCal, its that they have 20 kCal on average.  

I really wanted to be able to trial breast feeding in the hospital to see if he ate long enough, had adequate weight gain and adequate output.  I'm frustrated that they aren't willing to try that when he's clearly gaining weight even when his intake isn't what they were wanting.  I'm even more frustrated that they only prepped minimum intake requirements each feeding and I had to ask for more.  Overnight when I slept, they only fed the minimum even though he would take more.  The nurses had orders for 45 mL per feeding ad lib so that's what they tried to have me do.  Then I get stuck fortifying because those orders meant his intake wasn't around 112 mL per feeding which is what they were looking for.  C wants to eat about 60-80 mL per feeding and I think he'd do just fine on that.  I wish they'd let me test it.  It also seems that C is unlikely to cry when hungry as a rule since we've always fed him every 3 hours whether he is awake or not.  I hope he gets to demanding food soon, it would be helpful to know when he's ready to cluster feed for the evening.

I'm going to try to talk to the resident again, but I'm afraid that each time I do, I  prolong our stay here.  Maybe I'll try and work with my pediatrician to deal with this.  Though its a greater risk of cold/flu infection to go there.  *sigh*


  1. WHAT? That is ridiculous. Stick with your gut and I cannot believe they wanted to keep him over the weekend :( How did this all end up going? Breast feed. Do it! And you are right, it's average 20kCal. AND, if there were issues and you are determined, you can pump off the fore-milk and give him the hind-milk, which is way higher in calories.