Lactnetters,

I've just come across a problem and want to see if anyone has any other
ideas.  I was seeing a mother and baby at home because the baby had a
bilirubin of 20.  I had the phototherapy lights set up and taught the
mother care, etc.  She was a breastfeeding mother and I of course
assessed feedings and nutritional status.  I was surprised to find that
the baby was stooling and wetting plenty-10-12 times/day-and eating
every 2-3 hours, but had lost more weight than at discharge and was now
2 1/2 weeks old.  Mother appeared to have an adequate milk supply and
baby swallowed plenty at each feeding.  Mom did say that baby had been
very sleepy and sluggish at feedings.  I suggested she wake the baby
every 1 1/2- 2 hours during the day to feed and not let her go longer
than 3 hours at night between feeds.  Mom did this over the weekend and
when I saw the baby today she was much more alert and not very jaundiced
anymore.  I will just have to wait for her to get the weight rechecked
to see if she is gaining.  Anyone have any ideas as to why this baby
continued to lose weight?  The other problem is a terrible diaper rash.
Could the dark stool from the excretion of the bili cause a bad rash?
Her bottom is raw.

Thanks,
Kim, RN, IBCLC