brock8024

You never said that the mom was passing something BAD in the breast milk. So the baby has a genetic defect, decreased loa, seizure activity, poor perfusion and dark urine...does the baby have the genetic inablility to metabolize the protiens in the breast milk (there is a name for it, but without google, I can't remember what it is)

Brat :angel8:

I think you are on the right track. Ok so if this is what it is how would you confirm it ?????

you guys and gals are so close just need the right question and you got it. this mom is very quite and only tells what she is asked nothing more so you got to ask more stuff

What colour is the urine that the child has been putting out? Is it winter? Has mom been eating a lot more meat that usual or did she take any extra pre/post natal vitamins?

Brat :angel8:

there we go back on track. The urine is darker than normal. You guys almost have this nailed just a few more things to ask.

Could this be a genetic problem? I know that in Amish Communities, the sometimes marry closely within families. I also know that sometimes Amish Children deal with rare metabolic illnessess because of the tightness of the community, no vaccines, and other factors. I guess Mad Cow Disease is out of the question because you said "has nothing to do with animals.?

You are on the right track. LOL This is a genitic problem.

heart sounds? and I don't think we ever did get a pulse or try for a BP on this poor child...this is going to drive me nuts!!! Was the child born at home? Was it a normal delivery?? Were there any problems? (like cord around the neck, etc?) Did the mom deliver a normal, whole placenta? Has mom been sick?

Brat :angel8:

Bp is 82/p the best ur partner could get.

heart sounds? and I don't think we ever did get a pulse or try for a BP on this poor child...this is going to drive me nuts!!! Was the child born at home? Was it a normal delivery?? Were there any problems? (like cord around the neck, etc?) Did the mom deliver a normal, whole placenta? Has mom been sick?

Brat :angel8:

Ok normal delivery at home. No problems. CM shows sinus tach at 182. hard to get on a 5 day old. LOL

Did the mother have Codeine after birth?

I am interested what the narcan result is.

no codiene. LOL

There is a tool that is used in assessment that has not been used.

equal grips? equal pupils?

Describe the sz. Tx with whatever your local meds are...ex valium.

Narcan? (yeah, not great assessment tool...esp after valium)

tonic clonic sz. ok so u gave the meds and the baby is not having a sz anymore. Nothing happens when you give narcan.

What tool have you not used. LOL

Well, since you said she is passing something on...could it be Listeria? Mom does live on a farm and mom has probably been eating soft cheeses, especially if made with unpasteurized milk. Listeria has been found in breast milk, but is rarely passed from mother to baby through milk. It is usually passed through the placenta during pregnancy or through vaginal bacteria during birth. Newborns can develop the disease a few days or even a few weeks after birth. So if that is the case it could just now be developing listeriosis and the baby is experiencing the n/v, diarrhea, and convulsions, and decreased LOC that occur when the bacteria starts affecting the nervous system.

sorry wrong

"Bovine Spongiform Encephalopathy" fancy word for 'mad cow' (sorry, farm girl talking here)

Ok, so it's not animals. You mentioned no masses on the head...how 'bout on the abdomen? And while we're at it, let's listen, heart sounds? Bowel sounds? Something is causing decreased perfusion....but it's not infection or there would be a fever....thinking out loud...

Brat :angel8:

No masses and bowel sounds present

I'm going to guess Meningitis

Nope

Ok, so mom is passing something in the breast milk, something that she doesn't seem to be reacting to...at least not yet...is there a possibility that their farm, or the neighbours farms have had an incidence of sick animals...namely COWS??? (I have to check to see if BSE can be passed through breast milk...)

Brat :angel8:

What is BSE????

It has nothing to do with animals

Does the baby seem to have increased saliva?

Nope just not taking feedings well.

There is a assessment tool that people have not used. LOL there is another hint

Lets try an End Tidal CO2 reading and see what we get. Also establish IV and NRB.

I am also going to try putting the baby on the stretcher with his knees to his chest. Possibility that the baby is suffering from Tetralogy of Fallot, and the knee-to-chest should provide temporary improvement by increasing systemic vascular resistance and encouraging deoxygenated blood into pulmonary artery rather to systemic circulation.

Intermittent persistent fetal circulation is another possibility.

You have a IO. You give the Oxygen and have a ETCO2 reading of 40mmhg

Is it well-water? Boiled?

it was boiled. Ok i am going to give you another hint. We can not fix this baby in the field just treat s/s. OK now someone got close to asking the right things but did not. I am trying to help without giving it away.

Could this baby be allergic to something that the mom has been exposed to? Since she is breastfeeding, she could be passing something along in her milk that is causing the baby to be sick. Are any of the animals sick? Brock you're killing me here, you know i don't like pedi calls and i hate mysteries...

I am sorry I am killing you. I will have to watch at work this shift. LOL Mom is passing something on in her milk but what is it??????

Family is amish...so no vaccinations...you mentioned a farm, how 'bout mom drinking unpasturized milk? Sugar is normal, cap refill is delayed, so perfusion is slow. What were O2 sats with blow-by? I think you said afebrile at 99 degrees, loose stool...are they on a cow farm???

Brat :angel8:

sats are hard to get due to decreased perfusion. They have many different farms in the community.

I googled it, and got 70-120 for a norm...so taking that, the baby's sugar is normal...what about pupillary response? Chest sounds? urinary output? Why did they take so long to seek help?

Brat :angel8:

pupils are slow to react. lungs clear. output is less than normal. The family is amish that is why.

As you load the baby up it has a seizure. Anything else you want to know. You are on the right tract just got to ask the right question and you will have this nailed. I gave you a big hint.

Blood sugar??? (please state normal range since I can't remember the US norms). Has anyone else been looking after the baby lately? Other siblings? Do mom or dad have history of violent angry outbursts? Has mom been assessed for post partum?

Brat :angel8:

fsbs is 82 mg/dL. I am going to have to look that up. I can not remember ( i am embrassed).

Mom and Dad both look at you upset for thinking they could have hurt their child. Just other women from the community has been helping with the baby.

Has baby been circumcised? If so when.

Baby is uncircumcised.

How much water has the baby been given? How was it prepared?

About 1/4 of a small bottle. It was prepared in a normal fashion for this family.

Did they take the baby anywhere "different" like a farm or camping recently? Adding on to anthony...anything at the scene that could give clues?

They live in a farming community

Anything of note in the baby's sleeping area. Anything found on a total body check (insects, wounds)? Pupils? What has the parents/baby activities consisted of since birth? Any outings? Any visitors?

Is this acute? Progressively worse?

No outings, just famly as visitors, and no wounds or bite marks. Baby sleeps in parents room. mother is a stay at home mom and works as a farmer. baby has been getting worse

Is anyone else in the house sick? Headache, nausea etc. Gas or electric heat? What is baby's skin color? How long ago did this baby go to sleep?

baby not acting right. hard to wake up and just looks around blank. no one else sick

Has baby been given any medicines? What has his diet consisted of since born?

no meds and breast milk. Mom tried to give baby some water since it was not taking the milk well.