hi donna,
here are some of my thoughts on your case. first, let me say that if a baby
goes 5 hrs, that in itself is not necessarily a problem. if the baby is
feeding EFFECTIVELY, lots of pees and poops, then this may work for him. i
will say that going 5 hrs between every feed would seem very unusual and out
of the usual of what i'd expect to see, but going 5 hrs once in a while or
once in a day would be within normal limits, IMO. again, if all else is
well.
now to your specific case, i gather that the baby goes about 5 hrs between
all feeds. you report that on day 2 the mother called w/ problem of painful
cracked bleeding nipples. of course this is a big red flag for poor latch.
as you know, when babies don't latch well, they don't usually get much milk,
and very often get lethargic from lack of calories/hydration. the parents
accounting of the wet and dirty diapers is not too reassuring, as usually on
day 5, if all is well, the poops are really happening, often w/ each feed,
and the daipers are really soaked. i usually ask if they ever saw the baby
pee w/o a diaper on. especially a boy it will hit you in the forehead. that
is often a good sign of good hydration. often the baby poops while feeding
at the breast as the warm milk starts to fill the tummy (the gastrocolic
reflex). what about the mother's supply? yes she "drips" milk but did she
get full breasts on day 3,4, or 5? does she hear baby gulping milk and see
the slow/open/pause/close sucks.?
now the most important part: you say "I'm getting seriously concerned that
baby is lethargic, jaundiced and dehydrated." donna, do you mean you saw him
and he is this way, or you are wondering if he is this way? if he is
lethargic, dehydrated, and jaundiced, this is an emergency and baby needs
hydration/calories. it warrants, at the very least, a call to the ped so
that you can report it to him/her. If you are just worried about it, then
you must ask more questions of the mom so that you can ascertain the
situation. in my experience, jaundice can be very difficult for parents to
assess. depending on what answers you get, and on what you have seen in
person, you would have to be very frank about the situation w/ the parents.
expressing and feeding might certainly be the ticket til baby perks up.
also, remember that poor feeding is one of the earliest signs of illness,
infection, heart problems etc.
Laurie Wheeler RN, MN, IBCLC, RLC
New Orleans Louisiana, s.e. USA




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