Jude, Before you resort to supplementing with ABM please consider a couple of points; 1--A baby not back to birth weight by day 5 is not a concern. Most babies will drop from birth weight for the first 3 days, by day 4 they typically plateau out and then by day 5 are starting to increase their weight. The guidelines we follow (and have never had problems with) is that baby be back to birth weight by 2 weeks. 2--There may be other influences at play with the jaundice; was there birth trauma (bruising) that would explain the presence of more by products of RBC destruction? Was the mother exposed to prolonged IV pitocin production? These are just 2 possibilities and this is all just IMHO. Thanks, Mary Anne B. Mary A. Banaszewski, RN, Lactation Specialist ---------- > From: Tim and Jude Kurokawa <[log in to unmask]> > To: > Subject: Re: Bili lights, ABM, Re: Jaundice in Breastfed Baby > Date: Thursday, November 13, 1997 10:33 AM > > Thanks for your reply. I realize there are no pat answers, but I > appreciate your thoughtful response. I think I may need to have some > nursing supplementers on hand, as this sounds like a workable compromise, > as much as I dislike the idea of ABM. > > I do always rule out hemolytic disease as much as possible by getting > Coombs, and smear for hemolysis, type and Rh, and in the last 10 years have > only seen one ABO problem. The rest have been pokey, sleepy babies not > getting enough calories, often in primips with milk slow to come in for > some reason, or else exaggerated bm jaundice in the 2nd 7 days. > Interesting in the native American population I see bm jaundice frequently, > and it often lasts 6-8 wks, w/ bili's of 12-14 up to that time, then just > resolves. People are finally figuring out that these babies are fine, just > yellow, and don't need to be treated, for crying out loud. > > A neonatologist recently advised me to try putting the lights quite close - > 13 inches - from the baby, as well as the wallaby from below. There were > some temp regulation problems with baby getting too warm (we had heated the > room pretty good), but solved that and the bili dropped from 21 to 13 over > night, with no ABM. Sure goes against regulations, but it worked well, in > this series of one : - ) Have you seen any lit on this idea? > > Jude > > > VvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvV > Jude Kurokawa, CNM, FNP-c Only Cowards cook on low. > 513 Dayton Street > Wolf Point, MT 59201 (where A Coyote midwife sits by the hole and waits...) > > > Mailto: [log in to unmask] http://www.midrivers.com/~jkuro > > > > > > > ---------- > > From: Lawrence M. Gartner <[log in to unmask]> > > To: Tim and Jude Kurokawa <[log in to unmask]> > > Subject: Re: Bili lites, abm, Re: Jaundice in Breastfed Baby > > Date: Thursday, November 13, 1997 8:33 AM > > > > First, my concern is that the infant is still below birth weight at 5 > days. > > This suggests that the baby is not getting as much milk - or calories - > as > > you think he is. Is this infant getting primarily foremilk? How long is > > each nursing episode? > > > > In answer to your specific question: This is part of the art of medicine > > and one must use judgement and a little trial and error with careful > > monitoring. If the bilirubin is above 20 but less than 25 and the infant > > is tlruly healthy, thriving and of good weight, and hemolysis has been > > ruled out as best one can, then continuing breastfeeding and > supplementing > > with formula using a nursing supplementer would be one option. The > other, > > but number two option, is to continue the breastfeeding and use > > phototherapy. If the bilirubin is rising rapidly or is heading up toward > > 25 despite attempts to increase milk production, frequency of feeding, > etc. > > and use of supplementary formula and/or lights was not promptly effective > > (within 24 hours) then I would interrupt breastfeeding for 24 hours. > Also, > > keep in mind that there are other causes for high bilirubins including > > inherited metabolic problems, undiagnosed hemolysis, etc. > > > > I hope that helps - there are no simple answers. > > Larry Gartner > > > > > > > > > > > Lawrence M. Gartner, M.D. > > Professor of Pediatrics and Obstetrics/Gynecology > > The University of Chicago > > MC6060 > > 5841 S. Maryland Avenue > > Chicago, IL 60637 > > Phone: (773) 702-0389 > > FAX: (773) 702-0764 > > E-Mail: [log in to unmask] >