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[Dysphagia] Infant question
Suggest the baby be tested for GER as well, as not all babies with GER
vomit. A swallow study will allow you to assess the nasopharyngeal and
oropharyngeal airway as they may restricted.
Robert Beecher, M.S., CCC-SLP
Senior Speech/Language Pathologist
Board Recognized Specialist-Swallowing and Swallowing Disorders
Masters Family Speech and Hearing Center
Children's Hospital of Wisconsin
-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
Behalf Of Susan O'Neill
Sent: Thursday, December 14, 2006 7:31 PM
To: Dysphagia at b9.com
Subject: [Dysphagia] Infant question
I would like input from the group on the following case. I am working
with
an infant in the NICU who is now 40 weeks post conception, was born at
36
weeks via C-section to a healthy 19 year old mom. Infant weight at birth
was
1490 grams and dx was intrauterine growth disorder. Apgars were 9, 9.
Infant has been stable on room air. She has had growth and feeding
issues.
Gag, root, suck, transverse tongue reflexes are intact. Suck on
pacifier is
vigorous and coordinated. When nipple feeding is attempted, suck
becomes
weaker is poorly coordinated with swallow & breathe. Infant takes
10-22cc/feeding and the rest is gavaged (goal 40cc of 34 cal formula).
Initally nursing was using a standard similac nipple. I noticed lots of
oral
loss, increase in respiratory rate with feeding (from 30's to high
50's),
some coughing and sneezing (rare, but present at least once each
feeding),
I tried our slowest flow nipple and it wasn't a whole lot better and
intake
was less. I have switched to Haberman on the slowest flow and we no
longer
have oral loss or a signif increase in respiratory rate. Intake remains
quite low (driving the nurse's nuts.they blame it on the nipple) and
coordination of suck-swallow-breathe still not 1:1:1 by a long shot.
I've
tried pacing the baby to get her to swallow more often, since I feel she
is
repressing the swallow, and when she finally does swallow, it is too
big.
At present, I have recommended an MBS for more information, but
neonatologist is reluctant. I am concerned she is aspirating some and
this
shuts her down. Even when her state is great (quiet, alert) she'll quit
after 10-20cc and start to gag/refuse to root when offered the nipple.
I
would like to get your ideas on how else I might proceed or if I should
"stay the course" and hope she starts to get it now that we are sticking
to
the Habermann (I have the staff's agreement to stick with one nipple for
a
week, as they were changing the nipple every shift and I felt we weren't
giving the poor baby a chance to learn and get used to anything). The
neonatologist says neurologically baby looks good, but I do think there
are
some dysmorphic features with this little peanut. She is getting a
chromosome workup per my observations, but it is still pending. Thanks
in
advance for your time and advice. Much appreciated.
Susan O'Neill, MS, CCC-SLP
NCH Heathcare System
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