I just wanted to mention that it is a common belief that jaundice (or
hyperbilirubinemia) causes drowsiness and lethargy. This may be true.
However, it is also quite possible and even probable that lack of calories
and nutrition are causing the drowsiness (lethargy). It worries me that baby
has spent days under treatment for hyperbilirubinemia with bili levels up to
20 and now down to 14, but is just now being addressed for weight loss. In
my opinion, the calorie deprivation needs to be addressed immediately, and
typically babies do a big weight gain, like 4-8 oz overnight, once the
calories are being given, and the bili levels come down pretty well. Once
the big catch-up weight gain is seen, the baby typically goes on to gain at
a more normal pace.
I think there was another case where baby was gaining very slowly and was
FTT category. I do not believe it is healthy for such a baby to struggle
along with 1-3 oz gain a week for maybe a few weeks, when they could be
gaining well on some supplementation. This would not necessarily be the case
for a well baby who had not lost much weight, and was now steadily gaining
maybe 3 oz per week. I wouldn't like this alot, but would be more inclined
to follow closely with a physician, and maximize milk transfer and milk
production. The FTT situation requires supplementation in my opinion,
correct me if I'm wrong, he wasn't being supplemented.
For the baby who was getting Alimentum, I woud advise mother to use hospital
grade pump and galactagogues, and attempt to increase her supply and
supplement with her own milk, and protecting her supply for later months.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA
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