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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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My baby was born last night and she was 38 weeks and 2 days.

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My baby was born last night and she was 38 weeks and 2 days. After birth, they notice she has some breathing problems where she might stop breathing for a few seconds and then start again. Her oxygen intake will go from 95ish down to 80ish. They think its because of the morphine I took during birth that went into her system. The used the morphine reverse drug on her and she's doing fine. Couple of hours of smooth breathing, she has the same problem again. This time they rule out the morphine because it should be out of her system by now. She's screaming and crying fine. All they need to do into pat her and she'll be breathing again. She's 7.6lbs at birth. They couldn't figure out what's wrong with her at the moment and is running all sorts of tests. I want to know how serious this is and will it be life threatening. She's in the nicu right now

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

Hi. I'm sorry your baby is having problems. With a normal birth weight and I assume no problems with your pregnancy, labor or delivery, normal Apgar scores, etc she is likely just having some temporary issues with her lungs.

Dr. A. Clark :

We see full term babies do this sometimes, including my youngest daughter who quit breathing on the second day due to some retained fluid in her lungs.

Customer: I don't know what the agar score is. They wouldn't see that on the chest X-ray? They did that on her and found nothing
Customer: Now they're doing blood cultures, lumbar puncture, head ultrasound tomorrow. Sounds serious but she's less than 24 hrs old and her oxygen level dropped around 10 times total
Dr. A. Clark :

The Apgar score is a measure of a baby's alertness, heart, breathing, reflexes, etc and is done on all babies at birth, one minute and five minutes of age. If she had problems at birth you would have known it and they would have had to give her oxygen and perhaps stimulate her to get her to breathe when she was born.

Dr. A. Clark :

The tests are routine in any baby with her history to rule out infection, bleeding in the brain, etc but as with my daughter, these are the usual precautions taken with all babies who have any problems like hers and antibiotics are given and her heart will be monitored as well as her oxygen.

Dr. A. Clark :

There are several problems that can be ruled out with the tests they've done and have ordered and I can tell you that most of the time this clears up in a day or so.

Customer: They notice her turn a little blue 3 hrs after birth so send her to nursery for monitoring. But she had 4 episode of dropping within 1 hr 4 hours ago so they transfer her to nicu for better monitoring. I was at nicu with her for 2.5 hrs and nothing happened during that time
Dr. A. Clark :

Is she on oxygen now?

Customer: Nope. Not on anything. Just monitoring machines
Customer: weird thing is those episodes always happen when I'm gone and she went back yo the bed
Customer: We've never seen it happen when we're trying to feed her or holding her skin to skn
Customer: Oxygen is always above 95 to 100 when we r there
Dr. A. Clark :

Good, that means her lungs are probably fine and she probably just needs a day or more to mature a bit. Some babies just take a few days to wake up good and remember to breathe.

Customer: About the wake up part. Yes. She's very sleepy and rather sleep than eat. Very hard to wake her up
Dr. A. Clark :

We see this all the time and as with my daughter, she will likely stop doing this in the next day or so and be ready to go home. The tests will rule out other problems like infection, issue with her brain, etc. Just hang in there and give her a little time. This is why we hate to see babies going home from the hospital at 24 hours or worse, delivering at home where problems like hers might get missed and tragic outcomes can occur.

Customer: shes on antibiotics now while they wait for test results.
Dr. A. Clark :

That is routine when cultures are done as we want to be ahead of the problem if an infection is going on but not detected for a couple of days with the culture.

Customer: So everything doesn't sound that bad then. Seems routine
Dr. A. Clark :

Give her a day or two and all of this should be cleared up but in the meantime she's being observed closely by the NICU.

Customer: And shouldn't be life threatening?
Dr. A. Clark :

We see this every day and most of the time, again with a normal pregnancy and delivery, everything will be fine.

Customer: Ok. It's just scary to hear all that
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Chat is having some technical issues so I switched us over to the Q&A mode.

Again, I would not worry too much as this is quite common and she should be fine in another day or so.
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Customer: replied 3 years ago.
Thanks for your help.
Customer: replied 3 years ago.
Hi Dr Clark, my baby's tests all came back normal and they've stopped antibiotics today. Thought she'll be all good now as there's no desaturation for a while. Today when she eats, because she sucks hard and fast, the o2 level went down to 85 ish while she's eating. Once we pace her, stop her every 5 sucks, she's fine. The next meal came along and she's starting to fall asleep while she's finishing her bottle and choked. Cough 2 times she's fine. Because of that, the ppl here decide to do a upper GI check where they run the dye and check how she swallow. They didnt find anything going down the wrong tract but they kind of see some fluid almost get to the wrong tract but pops back. Now they want an ENT dr to check her anatomy and see if there's anything wrong. If not, will find some OT that specialize in swallowing and see what can help her

Ultimately I just want to know how serious this is? She looks like she was too sleepy and nurse continue to give her milk so she choked. But it turns out to be another series of tests. My poor girl
I suspect it is just a matter of temporary swallowing problems (called pharyngeal incoordination) and the OTs will evaluate her to see if some therapy will help her if needed at all. I think given a few more days this will all be over so I would not worry too much as the swallow study (X-ray) ruled out any anatomical malformations, such as a trachea-esophageal fistula.
Customer: replied 3 years ago.
They want ENT to see her to see if she has a cleft. A hole in the voice box? She has been feeding well for two days. Screaming her lungs out when hungry. No choking whosoever as it was the nurses here feeding her. Yesterday she choked when I was feeding her as of course I'm a newbie with this. So one of the nurse was surprised nothing happened when they fed for so long and now became an issue. She choked half way through the botte as she was falling asleep. And they see desaturation if she's eating nonstop so they as me to pace her.

What's the chance of having that cleft? Is that a big issue?
A cleft would likely be visible since it is the palate but sometimes there can be what is called a submucous cleft where the hard palate has a cleft but the mucosa covers it. This does NOT usually cause any swallowing problems or choking. I'm not sure what a "hole in the voice box" means!

All babies desaturate while eating since they hold their breath while doing so when a bit premature. This will get better over time and is not a concern really. If you put a pulse ox monitor on any baby in the nursery you'd see the same thing!

I still think all of this will get better over time but having OT and ENT take a look at her is a good idea.
Customer: replied 3 years ago.
I found the term. It's called Laryngeal Cleft. They want to see of she has this.
Rare but worth a look.
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Customer: replied 3 years ago.
Hi Dr Clark, my baby's swallow study was completed today and we found out she aspirated on all thinner consistency until they tried honey consistency with slow nipple. With this combo,there was close to no penetration. So the OT suggest us to use a Ng tube to feed her for the next 3 months and use a little of the honey consistency milk in a bottle to continue to stimulate her suck. There's no anatomy issue, they basically said her suck is very strong where the throat can't keep up. Is this a common issue? How's it like to feed through a tube? Will that affect her development? I can't believe she has to be attached to a tube for three months and potentially more pending on her 3 months review.
This is typical pharyngeal incoordination and while not real common I've seen quite a few kids with it over my 34 years. Tube (gavage) feeding can be done by passing a tube each time but more commonly they place a tube through the nose to the first portion of the small bowel and leave it taped to the face and you just plug in a pump every few hours. It does not affect development at all and all they need to do is repeat the swallow study later to make sure she is able to swallow without risk of aspiration.
Customer: replied 3 years ago.
They are feeding her through an Ng tube and will continue for three months. They said we have to learn how to put in the tube etc. what are the chances of her having better coordination at 3 months?
Much better if not sooner than that. Be patient and follow the OT's recommendations as they really know this stuff.
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