I am starting to hear about the sentinel event/jcaho etc at our hosp. one
pedi recommends strict 4 hr feeds for all 'his' babies. this is seen to be a
problem because it is recommended 8-12 feeds/24 hrs. this is the same pedi
who will not 'allow' the LCs to see his mothers.

Good bf management and support are critical to reducing hyperbili and
adverse events. One other thing that is very important is early follow up.
The norm in my community is 2 wk f/u with peds. This is common even w/
small, near term infants and others at risk. I have seen many many times a
baby w/ poor feeding and rising bili discharged on day 3 w/ a 2 wk f/u. This
will miss the critical period of high bili and not knowing if mom's milk
will come in, or how baby will improve or not w/ feeding. I send reports to
the docs urging them to f/u in a day or two and I educate the parents
carefully on risk factors and possible need for supps. I also do f/u calls
and wt checks. But I do this w/o peds support.
Do not forget to include early f/u w/ peds, NNP, LC, or at the very least a
phone call in any policies or care plans/care pathways you develop.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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