annie,
this baby is at serious risk of dehydration and wt loss in my opinion. the 
jaundice will likely increase due to poor feeding including vomiting, and 
the hematoma.
(red flags from your post: vomiting, no stools today,  large hematoma on her 
head, does have some jaundice, Very sleepy at the breast).
if there is a blockage the vomiting is usually severe and the abdomen gets 
distended and loses bowel sounds. baby generally looks very ill.
i'm even wondering if there is a neuro component to the vomiting, altho more 
likely this all will resolve in several days as the baby recovers from a 
difficult birth. however the baby can get into trouble in the meantime if 
not protected.

recommendations:
find a healthcare provider that is really taking this seriously and will f/u 
closely. this is not a baby who needs to go home and return to peds in 2 
wks! i would recommend continuous kangaroo care (baby upright), make sure 
mom pumps frequently w/ a top quality pump to preserve her supply, hand off 
to dad when mom pumps. i agree w/ freqt small feeds but i believe in 
calculating what baby needs because often i see severe underfeeding in these 
cases. the physician needs to be kept closely apprised of the intake and 
output and the baby may even need an i.v. for a time and some phototherapy 
if the bili gets too high (i.v. not because of the juandice, but if baby 
really cannot keep food down). i hope if this is the case, the phototherapy 
can be done at home or if in hospital they are family friendly and allow the 
famiy to be together (rare in my experience). an easy calculation i use is 
2.5 ounces x baby's wt in pounds = approxmate 24 hour intake needed. divide 
this into hourly feeds if necessary. (example for a 6 lbs 4 oz baby--> 2.5 x 
6.25 = 15.6 oz per 24 hrs; or .65 oz per hour or 1.3 oz every 2 hrs). 2 hrs 
feeding may be more manageable for all.
(you probably already know this, but others may benefit).

Laurie Wheeler, IBCLC, MN, RN
Tupelo Mississippi, s.e. USA

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