Kathleen

Having worked with two babies in the last week whose bilirubin levels went
up to 20 and 26 within a day or so of hospital discharge, I am feeling very
jumpy about the situation you describe.

First thought:  Has this baby got some kind of infection?  Could be
something you can *see* (e g rash, sticky eye(s), inflammation around
umbilicus) or something you can't see (e g urinary tract infection,
septicaemia).  These kinds of things can cause poor feeding, high jaundice
levels and low/nil gain.

Secondly:  what is the bilirubin level?  Perhaps this needs to be checked,
and if too high (approaching 20, or more) then phototherapy?

Thirdly:  you seem to have covered everything as far as *feeding* goes -
breastfeeding and topping up, and pumping afterwards.  I don't think this
could be improved on.   You don't mention baby's birthweight, or current
weight.  Perhaps increasing the amount in the SNS so that baby receives 180
ml/kg/day (EBM first as much as mom can pump, then ABM as you suggest) would
start to turn this around in the right direction, then patience.  Mom sounds
very frustrated, but she would be feeling less full at Day 8 - 9 anyway,
even if everything was going swimmingly.  However, thinking of attending
conferences etc. with an 8 day old jaundiced baby who is not gaining is
madness (trying to be supermom?) - something will have to give!

This sounds like *more* than just a "feeding-problem" IMHO.  Keep us posted!

Pamela Morrison IBCLC, Zimbabwe