.sond nasogastric

sond nasogastric  (in french).  or NGT.  or lifeline.

 I never thought I'd be putting in infant feeding tubes but I guess all those harsh nights in the IMCU payed off in some way. 

this baby is Bria Suzanne. 

2 weeks old.

 the first cleft palate I've ever seen that isn't in a textbook.  Medically speaking, she has a unilateral cleft lip cleft palate.

dehydrated, malnourished.

 the parents keep a blanket over her face most of the time.

 she isn't able to breastfeed, not that most mothers breastfeed anyway here.

it is common practice not to feed the baby 3 or 4 days after birth and then give it water.  water from village wells.  water they bathe with.  water that isn't boiled. 

there is a cultural misconception that the colostrum will harm the baby.  Also that babies need water. 

Danae (the OBGYN) will talk until she is blue in the face, "ONLY breast milk. no water."  D'accord.  D'accord.  they will nod and click and cluck.  minutes later, the grandmother is giving it water. 

and round and round we go. 

there are also a startlingly high amount of umbilical hernias here.  One of the volunteers here, Tammy Parker, has actually witnessed a ritual that they do to many of the newborn babies.  The midwife or other will hold their hands in the fire until it is as hot as they can stand it.  Then, they will push as hard as they can all around the umbilicus.  they repeat this until they get the chord off.  no literature that I have seen supports it, but we all surmise here that is the reason that roughly 2 out of 3 children in the village of Bere have umbillican hernias. 

anyway

so.  we get this baby.  and none of the six nurses standing around know how to put in an NGT.  well, if there is one thing I know like the back of my hand, its that.  Finally, something I have done before. 

nurse:  Lay the baby down. 

me:  NO! sit the baby up.  like this (comme ca)

nurse:  no, lay the baby down.

me:  No! comme ca.


so then we establish that laying down is not the optimal position.  fabulous.

her mouth is dry and cracked, so I had the mother expess some milk and gave it little bits with the siringe.   She was swallowing it well so I told the other nurse to do the same while I put the tube down. 

nurse:  What are you doing?  don't do that.

me: NO!! give it milk like this

nurse:  no, we are supposed to give it through the tube.

me: YES! but this will help get the tube down.


and round and round we go.

and the same argument about measurements of the tube.

so finally the tube is in.  after an arguement about how to cut the tape.  i probably should have just given in on that one. 

so then, I explain how we need to listen to it in the stomach. 

I show then how to check for placement with a small air bolus and how we should hear it gurgling.  and how we need 2 other nurses to confirm as well. 

so, instead of doing it like i said, he puts the stethoscope to the abdomen and says "I hear it."  without the air bolus.  those are some great ears. 

and round and round we go. 

and then i wrote out this long thing in french about checking placement before each feeding.

then Marci Anderson, MPH and also a lactation specialist, came in and calculated exactly how much we should feed her.  and i left instructions on that too. 

every 2 hours.  20 ml. 

I hope they feed her.

how sad is it when you work in a hospital where you HOPE  the nurses will wake up to feed a baby. 

but, I actually have great hope for this baby.  She got fed all day today.  She looks better.  Her skin looks better.  She has a strong cry.  We started her on antibiotics for her fever.  Her mother has great milk production.  I think she is going to make it. 

.......

I actually am enjoying Pediatrics.  It challenges me the most.  It is also the most interesting.  and the saddest. 

but.  

bright spot:  I GOT MY FIRST BABY IV TODAY!!!!!  5 months old!!!  the countdown is on.  I'm so excited. 

and really, when else do you get  to see 2 cases of  Burkitt's Lymphoma, 3 cases of measles, meningitis, cerebral malaria, chronic anemia, periorbital cellulitis, and every other presentation of malaria all in one day??