I second Rachel Myr's comments on breastfeeding and bilirubin.
Since it is true that formula fed babies generally have lower bili levels,
and breast babies have higher and are at higher risk of hyperbilirubinemia,
you can't use the argument that breastmilk will clear bili levels faster.
You can make the argument that lack of breastfeeding will lead to higher
bili levels (not bf often enough, not bf effectively e.g. poor latch). How I
would approach the peds would be to let them know that unfortunately I am
seeing lots of moms who abandon bf, become engorged, or develop low supplies
after they have had to supplement or substitute formula for bf. And I would
like to find a good compromise between helping babies clear their bili
levels and preserving bf. You might identify babies at risk (like premies or
near-term infants), and ask that the docs make sure those babies get a
lactation consult. You might identify babies that need early f/u, you might
suggest that more education is needed for staff.
I tell you a wonderful thing that we use here is a transcutaneuos bilirubin
machine that allows you to easily screen and monitor babies non-invasively.
We follow these babes in the bf clinic, sometimes checking their bili levels
daily for 2-3 days, while also monitoring and helping with the bf and
weighing. I believe it cost about $5,000 US dollars and each tip you use
cost something (the tip is a charge item). It is definitely worth it if
their are capital budget funds or a hospital auxillary or volunteer dept
that will pay for this device. I just love it.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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