I would be very concerned about this dyad. First, if baby is being
supplemented with 2 oz x6 each day, that is a large portion of his intake.
Is this the mother's own ebm or a donor's ebm? If it is the mother's, then
obviously baby is not breastfeeding effectively and needs evaluation and
assistance.
If this is donor milk, then mother again is having low supply and needs
evaluation and further help.
I do not think the domperidone is slowing down the baby's bowels.
While it may be that the rare baby is gaining weight very well with only one
large yellow b.m. per day, it would be far from typical and merits
evaluation (in person).
I do not know the exact proportions of bilirubin in meconium vs breastmilk
stools. I do believe the meconium has a large amount and that later stools
have less. But my understanding
is that the baby could still be reabsorbing some bili from the stools. If
baby had a traumatic birth, as you say, perhaps there was alot of bruising,
cephalhematoma, or similar which would add to the bilirubin load.
Any time a mother is concerned and when there are the above red flags, this
would warrant a thorough in-person evaluation of the dyad.
Let us know how it goes.
Laurie Wheeler RN MN IBCLC
Mississippi, s.e. Usa

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