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Date: | Mon, 24 Oct 2005 21:53:41 -0400 |
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Wise Ones;
Please help me out. I have a client (permission to post) w/a 6 day old (40
wk) baby. 7#5oz at birth, 6#9oz low point(at day 5-8.5%loss), 6#11oz today
(day six). Mother overheard Ped telling nurse that dyad had a "blood
incompatibility"-she states that she is O+, baby is O-, but there was no
transfusion or discharge instructions given to mother regarding Rh
incompatibility. Baby's bili level was 12 at 72 hours, and then 18 at 144
hours. I know that these levels are not considered dangerous for the
healthy newborn, but am having difficulty translating the risks for an
infant with hemolytic disease. I understand that the AAP guidelines do not
apply to pathological issues.
I was unable to find information in either Riordan or Lawrence, but did
locate some info in Black, Jarman, and Simpson. I am concerned that this
info is dated 1998. The management guidelines for Rh incompatibility
include phototherapy/exchange transfusion/ administration of Rho(D) immuune
globulin to Rh- mother. This mother is Rh+ and the baby is Rh-, so this
obviously does not apply. Surely, a transfusion would have been given if
the baby needed one.....Is this still a possiblily at 6 days, or do the AAP
guidelines for healthy babies apply??
I am reluctant to show my ignorance by suggesting that the Ped reconsider
his order to feed Pedialyte in this situation. I suggested that the mother
increase the frequency of feeds, waking the sleepy (and non-stooling) guy
every 90 minutes to 2 hours instead of allowing him to sleep for 3-4 hours.
I gave her a very basic explanation that breastmilk has a laxative effect
and will help her baby clear the bilirubin by increasing the stools.
Can one of you wise ladies PLEASE clarify for me how the Rh factor figures
into the process when the mother is + and baby is -?
Niki Konchar, IBCLC
clearly, in the weeds on a medical issue, but still attempting to keep this
mother confident enough to continue exclusive breastfeeding instead of
Pedialyte feeding by bottle
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