ANY HELP FOR INFANTS?

[Nanner5]

My nephew was born at 26 weeks.   He weighed 2lbs 5oz and was in the NICU for a little over 3 months before being released last week at a weight of 7lbs 14ozs.    He was sent home on a bradycardia/apnea monitor as he suffers from severe reflux that causes him to have these issues.    He is on Metoclopram 5mg every 6 hours and also taking Prevacid 30mg every 12 hours.  

His bradys at the hospital were averaging about 4 a day.  Since we've been home with him he is up to about 8 a day.   They happen during his feeds.   He either falls asleep while eating, or refluxes so bad when he gets up the formula in his mouth he freezes and stops breathing/heart rate drops.  

My sister is so frustrated by not being able to help her baby with a task that seems so simple.    The brady's he had this morning were so bad it took a lot of stimulation to get him to come out of it.   I would like to know what kind of support there is out there for family's going through this same issue.   Could it be his medication is  not strong enough?    Are there any phone numbers support lines available??

Any assistance or light someone could shed on this matter would be greatly appreciated.  

[twns234]

I had 26 week preemie twins and all I can tell you is always what I hated to hear but give it alittle time. I know it is hard but it really will pass, I promise !! Just like everything else it is a stage.

Hope this helps!!

[ireneo]

A friend of ours went through this with their daughter. I don't remember all the details because it's been several years. But I do remember they had the monitor, the feeding difficulties and she would hold the baby upright for a long time after each feeding to avoid the regurg and possible aspiration dangers. It was a long year for them. But their daughter "grew out of it" so to speak and is a happy healthy little girl. Just a word of hope.

[Artaud]

Hi,

We all have room to learn a little more each day. Prior to today, I have never heard of the correlation of Reflux and Bradycardia in infants.

With this in mind, I did a little research and did indeed find many links. One that I found interesting mentioned the following items: The items in [ ] are my comments.
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"Pathophysiology

Similarities between adults and infants: For many years, GER [Gastroesophageal reflux] during infancy and childhood was thought to be a consequence of absent or diminished LES tone [lower esophageal sphincter, which is sometimes also referred to as the Cardiac Sphincter due to its proximity to the heart]. However, studies have shown that baseline LES pressures are normal in pediatric patients, even in preterm infants.

The major mechanism in infants and children has now been demonstrated to involve increases in tLESRs [transient lower esophageal relaxations]. Factors that may promote GER during tLESRs include increased intragastric liquid volume and supine [on their back] and "slumped" seated positioning.

Likely because of reduced viscosity and increased gastric volumes, the fluid diet of the infant facilitates the process of regurgitation compared with solid meals ingested by older children and adults.

Esophageal clearance is similar in infants and adults, although evidence of reduced peristaltic [the motion of the esophagus and intestine that moves the food through them] activity in preterm infants has been reported.

[The article mentions that an Anatomic factor that contributes to GER is:]

The angle of His (made by the esophagus and the axis of the stomach) is obtuse in newborns but decreases as infants develop. This ensures a more effective barrier against GER.
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My comments:
Being that an infant is involved, and more so an infant born premature, SIDS would be a concern that your nephew’s Pediatricians have considered, therefore I will not mention the recommendations that the article cited, other than to briefly touch on them. The article recommended a consultation with a pediatric gastroenterologist. In addition, the thickness of the infant’s formula (or, when appropriate, cereal) and positioning the infant, were also discussed. These issues must be coordinated between your nephew’s Doctor/s and the parents of the child.

Hope this is of some help. You do not appear to be alone with this problem. Have the infant's parents keep in close contact with the pediatrician if any concern arises.

Best of health to you and yours.