Parents of newborns: beware overreacting doctors with prescription pads

The Cradle Will Rock

Matt’s original e-mail birth announcement, sent to me and other friends of his in our office, described an ordeal in which his newborn son was unnecessarily admitted to neonatal ICU to treat acid reflux – a very common condition in newborns. (See yesterday’s e-Alert, “When the Wind Blows”)

Intravenous antibiotics were given to the baby, requiring seven full days in NICU. After that, Matt and his family would finally be headed home.

Or so they thought.

Unexpectedly, Matt e-mailed me again with new details that made me wonder if anyone is safe in a hospital anymore.

Speed feed

After a few days in NICU, Timothy was doing fine and Caroline was breastfeeding often. But unexpectedly, one of Timothy’s monitors indicated oxygen desaturation (a low level of oxygen in the blood).

So the NICU staff insisted on keeping little Timothy for another 5-7 day watching period.

These added days in NICU were discouraging enough, but Matt and Caroline soon realized that every one of Timothy’s low-oxygen periods occurred when they weren’t there and he was bottle-fed by nurses. (They only agreed to one bottle- feeding each day so they could return to their hospital room and get some sleep.)

The doctor dismissed this as a coincidence, but as Matt wrote: “The math seems pretty clear to me.”

Matt: “During our 9-day stay, Caroline breastfed Timothy about 80-90 times, no problems. He was bottle-fed milk 6 times, and all 3 of his problem periods occurred then. My dad (a former pediatrician) and a few nurses who confided in us think that in their rush, they bottle-feed the babies too quickly. This can cause choking and reflux.

“This probably occurs all the time in babies at home, but ones who are hooked up to Oxygen monitors in NICUs get treated differently.”

But the worst was yet to come.

Not in the book

The doctor continued to press Matt and Caroline to put the baby on an antacid drug. Finally, on the last three days of their stay in NICU, the doctor adamantly insisted on giving Timothy two oral liquid medications: Zantac and Reglan.

In addition, the doctor literally refused to release Timothy (to his own parents!) until Matt had picked up a 30-day prescription of Reglan. Matt actually had to present to medication to prove that he’d picked it up. But when he read the drug information sheet he was in for yet another shock.

Reglan doesn’t have a website, so I went to WebMD and found these “rare but very serious” side effects: signs of serious infection (high fever, severe chills), and signs of liver problems (persistent nausea/vomiting, severe stomach/abdominal pain).

And this: “This drug may infrequently cause a serious (sometimes fatal) nervous system problem (neuroleptic malignant syndrome).”

But here’s the most disturbing note, which Matt took directly from the information sheet: “Metoclopramide [Reglan] should not be used in children because of increased severe side effects.”

When Matt confronted the doctor with this, her reaction was the ultimate of arrogance. Matt: “The doc disregarded all of these concerns, they weren’t in the ‘book she uses.’ And even though there is no evidence showing its safety or efficacy in children, which she admitted, she was insistent.”

Matt adds: “All this despite Timothy acing his ‘PH Lead and Sleep Test,’ in which they shoved a tube down his nose to test the acidity of his reflux (if any). It showed his numbers to be perfect, and they were basic, rather than acidic.”

It could hardly be more infuriating! And to top it of (yes, there’s more!) at their first appointment with their pediatrician, Matt and Caroline were told that Timothy would need to undergo periodic hearing tests because hearing loss is a potential side effect of the antibiotics. But this information was never shared with them at the hospital.

What an ordeal! But finally I’m happy to tell you that Timothy, mom, and dad are all now safe at home and everyone is doing well.

I hope you’ll share these two e-Alerts with anyone you know who’s pregnant. Parents (and ALL hospital patients) need to be diligently alert to spot dogmatic treatment decisions, which are often forced upon us when we’re most vulnerable.

“Metoclopramide Oral” WebMD,