Pediatrician-types on lactnet:
I sent this privately to some docs already. Had a client today admitted to
peds for PATHOLOGIC jaundice. I may not be privy to all the details but here
is what I know:
3 day old, positive Coombs, ABO incompatibility, also facial bruising noted
in nurses notes at birth. Today bili is 20. BF fair to well (sleepy) and mom
can pump 3 oz with mini electric. Her milk is "in". I got her a classic and
double setup so she can express while bf is suspended.
Pediatrician ordered double lights, no bf x 6 hrs, but give sim w/ fe
instead, then resume bf with formula supps to top off, and suppository if no
stool in 8 hrs. I asked the pedi if baby could have ebm instead since mom
was producing lots of milk and we could measure his exact intake, and that I
felt ebm would help stooling more than formula, but he said no. He could not
come to the phone but I spoke to him via his nurse. So I couldn't explore
this further, but I wonder this:
Is there a rationale for giving formula instead of br. milk in cases of
pathologic jaundice? I understand how poor feeding or low milk intake could
exacerbate this but has it ever been researched and shown that formula
lowers bili levels faster than ebm or directly effectively bf? I've read the
'94 practice parameters and editorials, I understand that his tx plan is one
of the options in the parameters and that he is concerned with the hi bili
level and quick onset. I understand that formula fed babies stool more
volume and excrete more bili in FIRST 3 DAYS, but would this be pertinent
now? Alicia, I have not read your chapter but I wonder if you address this
type of a case.
I hope I have been clear about exactly what I am asking. Thanks for any and
all replies, as I live and learn, as always.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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