dosing an infant

[Amelia_mom]

hi Amelia finally made it back home. Bad news is she is readmitted when her INR tested 4.3. Her ideal range is 2.5 to 3.0. She does not show signs of bleeding but thee doctors are not taking chances.

At discharge her INR = 2.4 on 0.4mg
But after home it is slowly creeping up. This is the 2nd readmission due to high INR after her long stay in the ICU after her MVR.

Her doctors are holding her dose for today. She is the first baby to receive a mechanical heart valve .. so our experience on warfarin theraphy on infant here is really none.

Now her doctors are asking why on discharge it creeps up. My expressed breast milk? The way I serve?

So far she is slowing building up her stamina to bottle feed so when she is tired of bottle feeding the rest of her milk is tubed into the stomach. I serve her warfarin thru the tube.

Mr Lodwick you mentioned your youngest patient is also 5 months old so does fluctuating INR happen often? What is your advise? Do you also adjust the dose on infant much like an adult?

How do you advise how to serve the warfarin to infant? Does crushing the table affect the effectiveness? Does letting the syringed out warfarin sit (5 - 10 min) also affect the effectiveness. Does milk affect the digestion og warfarin too?


I am so tired sending Amelia to take blood test day after day. The doctor just feel safer that way. I just have this nagging feeling, they are adjusting too fast too drastic.

The ONLY thing I can safely say have changed is my milk flow. When she was recovering before discharge the milk supply was really good and exceed the demand. Now, I am BARELY catching up....

 

[geebee]

I am guessing big time here but I would think your diet might affect her INR. However, I would think that would be more inclined to lower her INR than to raise it. For example, if you eat a lot of foods high in Vit. K, that could be transferred to her via breast milk but that would lower her INR not raise it.

Al, does a mother's diet affect the baby's INR?

It sounds like there may be something done at the hospital that is not being done at home. OR, if they increase her dose within a couple of days of release, her INR will continue to go up as it takes 3-4 days for a dose change to show up in the INR.

Sounds like some investigation work needs to be done.

Good luck.

 

[Guest]

I have never been able to get a baby's INR to be stable. There are just too many variables. They spit up, they don't finish the bottle, tube feedings contain vitamin K and on and on and on.

Since you never know how much actually made it to the stomach or got absorbed, you have to just go one faith. Fortunately kids are very resilient. The INRs will vary anywhere from 1 to 8 (as high as my tester goes). The idea is to try to get them from being too far out of line for too long.

When testing more than once per week, it is absolutely a must that the total does over the last 7 days be considered. Then tweaks are made up or down by about 10-15 percent based on this. Bsing a decision on just the last dosage change will give no better than a random chance that the INR will be in range and the chances of two consecutive readings being in range by random chance is so rare that you do not want to think about it.

The longer it has been since her surgery, the less likely there is to be bleeding. I think that the best way to get her in range is to just "bite the bullet" and go with a dose for a week and test again. It is very hard and scary for both the doctors and the parents but it just about the only way that it will ever get stabilized. If you can't get the docrtors to agree to this, try for twice a week testing but always remember that the weekly dose must be considered.

You cannot expect this constant fluctuation of the INR to change until she gets to the point where she can swallow tablets and is able to eat regular meals.

 

[mupster50]

Hi, my name is Margie. my son is 28 now, but was very sick from day 1.

My advice is first, check with the LaLeche League if you have one. They will be able to tell you what things go through your milk. Then you can see if any thing you eat will affect the INR either way. This will help you to know what to eat and not eat.

When Tim began Coumadin at age 5, he was only 21 pounds. I had a hard time keeping his PT/PTT (that is what they checked at that time- no INR then) at a stable level. I watched everything he ate and then checked it all with nutrionists/or had them do research for me. I finally found out that peanut butter has vitamin K in it, and he loved peanut butter, so this brought the PT/PTT way down. It is just little things that are unknown that you have to look for. What vitamins do you take? Maybe there is something there. Doctors do not know as much about breast feeding as the la leche league. I would check with them and they can do research for you if they need too. you can always get in touch with me if you want too. Send me a email or if you really need to talk I could send you my phone number. Just let me know. you are in my prayers.
Margie

 

[Marguerite53]

My goodness. You mothers are so brave and amazing. Best of luck to you.

My comment would be for Amelia's mom. I cannot respond to the INR issues, but if you are having any trouble with your breast milk, please, call your local La Leche league or look up La Leche online. They have wonderful caring people who can help you with your milk production, flow, and who knows what else.

Again. Very best of luck......valiant little Amelia!

Marguerite

 

[catwoman]

The Singapore La Leche League group:

http://lllsg.tripod.com/

 

[KeegansMom02]

It is very tough!

It is very tough!

When Keegan was an infant we had a heck of a time getting him regulated! Like you, there were not too many of these procedures done on infants, therefore making it even more difficult! No one really knew what to do with the dosing. Then to mess things up worse, Keegan was on phenobarbital (sp?) for the seizures he was having post stroke...Those drugs work agains eachother...
It was a lot of trial and error...
We finally were able to keep it somewhat stable when he was about 4 mo old.
We had to home test him everyday, which was terrible, and we started him on baby food early! We would crush the pill(s) and mix them with a little bit of apple sauce or pears. This made things so much easier! Before we put him on baby food we were mixing his crushed pills will grenidine (per cardios idea) but that was a pain!!!

Good luck! it does get much easier!!!