Dear lactnetters,
I am rather new to lactnet and have read your postings with great interest for some weeks. I am a neonatologist in a birth clinic in Munich, Germany and still hopeful to be IBCLC this time next year. But for now, I need your advice with a now five-week old premie (28 weeks, 1100g at birth). She has been exclusively breastfed since her first week of life and is thriving very well. She is perfectly fine, has 1700g now and is scheduled for discharge home this week. She has been on phototherapy for physiologic jaundice for three days during her first week of life. Since then, her bili levels have risen slowly, but steadily to 12.5 mg/dl. She looks awfully jaundiced, but is drinking very well (mom comes in to breastfeed 3-4 times a day and pumps milk for additional feedings) and gaining more than enough weight. Direct bili zero. Liver enzymes normal. According to the weight-dependent algorithm used in this hospital, she should have pt again. But, in my poor understanding, this algorithm applies to physiologic jaundice (first 1-2 weeks of life), but not to mother's milk jaundice. Therefore, I have not ordered pt and assured the mother to continue bf. But what if bili continues to rise? PT or milk pause? Or both? And how high levels would you tolerate in this child? She is so fine with bf that I really would feel uncomfortable to suggest a bf interruption, even if just for one day. I am very grateful for your suggestions,
Regards and thanks,    Susanne