I had a frustrating day today at work.  One pedi is telling many of the mom's not to be picking up their babies too much because the baby will be exposed to too many viruses.  When I asked him about this he denied that he told the mothers not to pick up the babies -- he claims that he warns them against too many relatives and friends picking up the baby. And yet the nurses have heard him chastise the mothers for always holding the babies because they will cough and sneeze on the baby and cause it to become ill.

He also believes that if the mother has mastitis she should stop breastfeeding from that breast because the milk will be infected and if the mother has a fever she should stop breastfeeding the baby to "protect" the baby.  I had a long talk to him about all of this and he basically said " I know all about the research but that is all just theory and I know from experience what should be done and if I don't do the right thing and the baby gets sick then I am the one who is responsible."   Many of you may remember my post from a few months ago.

This is a so called man of science - but hey! forget about evidence based practice -- he will only go by his own evidence regardless of whether it may be flawed or not.

My second experience today was of another pedi taking a baby off breast milk for 24 hours because at 27.5 hours of age she had a bili level of 9.75 which put her just at the border of high -intermediate to high-risk jaundice. The orders call for feedings of formula and D5W.  I called the pedi  to discuss her order and she was quite patronizing.  She mentioned 23 Beta Pregnenolone as being the possible cause of the jaundice (she is talking about "BBreast milkJaundice" right???) I must have sounded ignorant to her because with her accent I couldn't quite catch what she was saying and had to get her to spell it out.

The pedi told me that she is actually doing the mother a favor by doing this because the choice was to continue breastfeeding but put the baby under lights right away, or to stop breastfeeding and keep the baby in the room with mom. The bilirubin is to be tested again at 37 hours and if it is still in the high risk zone then it will go under lights --- no mention of whether the infant will then be permitted to breastfeed.  The mother of course chose to keep the baby with her and stop breastfeeding.

This pedi thinks that she is doing the mother a favor because if the next bili level is down (I'm sure it won't be because I am sure it is not "breast milk" jaundice) then she will know that it is jaundice caused by the 23 Beta Pregnenolone and she will know it is "safe" to continue breastfeeding and not necessary to put the infant under lights. A mere 24 hours of formula feeding is barely a glitch in the overall breastfeeding experience -- hardly worth making a fuss over.

The logic is just so convoluted that I simply cannot follow it.

The pedi proceeded to tell me that she bases her decision on all of her reading of research as do all doctors and that is why some doctors differ from others in their approach to treating jaundice. Cheez!

Time to go home -- I think I will switch of my brain and just vegetate in front of the TV !

Cathy Loughman RN IBCLC



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