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Newborn and Infant Care

Antibiotics

08/16/2005

Question:

My daughter is 3 weeks old and has been on antibiotics since birth and will be on them for up to 3 months to prevent a kidney infection (she has hydronephrosis of her left kidney). At around 3 months she will undergo surgery. While I do recognize the benefits of being on antibiotics, I am concerned that they are killing the good bacteria in her intestinal tract. She seems to be getting fussier and fussier as the days go by. I`m not sure if she is just gassy from what I am eating (I am breastfeeding) or if the daily doses of antibiotics or making things worse. Is there anything I can give her to counter the effect?

Answer:

 This must be a very stressful time for you. She is so lucky that you have chosen to breastfeed because it it offers the best protection from illness possible and that is so important with impaired kidney function.

The most important place to start with an irritable newborn is to consider that there may be an infection present. So it is important to take her temperature with an accurate thermometer (battery-powered wand, temporal or tympanic thermometer) and to notify the doctor if her temperature is 100.4 defrees F or higher. Babies may still be ill even without a fever. Other signs of illness in the newborn are sleeping more than usual, awakening irritable with dull and glassy-eyes, feeding poorl;y and spitting up more than usual. If these symptoms are not present and the baby is well, there are several other causes for the irritability likely.

Among the reasons why your daughter may be becoming increasingly irritable, you have identified two - your diet and the antibiotics. It is true that everything you eat influences the taste of your breastmilk and to some small extent also may affect the baby's digestion causing gas and discomfort. The usual culprits are onions, broccoli, cabbage, and cauliflower as well as highly spiced foods. The only way to tell if this is the problem is to try eliminating these foods from your diet and seeing if the baby is more comfortable. If true milk allergy runs in your family, it would be a good idea to minimize your intake of dairy products and to take a calcium supplement instead, about 1200 milligrams per day.

Antibiotics do indeed alter intestinal flora as does breastfeeding itself, which promotes gram positive bacterial growth more than gram negative bacteria. Even if the antibiotics do contribute to gassiness, they are important to maximizing the likelihood of good kidney function now and after surgery. Some parents find that Mylicon drops offer relief of gassiness. They are an over-the-counter product widely available and best given after a feeding, 20 mg 4 times per day.

Another cause may be the pressure of the enlarged kidney itself on the intestines, slowing the passage of stool and causing constipation, hard stools that are difficult to pass.  If they are hard, contact your pediatrician. Breastmilk is the most digestible food you can provide and the least likely to cause constipation and its discomfort. If the stools are soft and easily passed, this is not the problem.

The enlarged kidney may also directly increase pressure in the abdomen and cause discomfort. Unless the problem resolves on its own, it will take surgery to relieve the increased pressure and its discomfort.

Finally, babies are quick to pick up on their parents' distress and to respond to parental distress with crying. If you are feeling upset and overwhelmed, your baby knows this and shares your upset. Anyone having a new baby can be overwhelmed, nevermind the baby having a  health problem, as does your daughter. So it's important to take care of yourself and get the help you need to be well rested and able to focus on what is important, your new baby. If you are feeling sad and down, talk with your doctor about the need for an antidepressant and supportive psychotherapy. Your baby needs her mother to be both physically and mentally present for her. Depression and anxiety make it very hard to nurture a baby.  While she has a significant problem, it is thankfully a fixable one for which she is receiving excellent care from her mother  as well as her doctors. I hope this information is helpful.

 

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University