Thanks for your reply.  I realize there are no pat answers, but I
appreciate your thoughtful response.  I think I may need to have some
nursing supplementers on hand, as this sounds like a workable compromise,
as much as I dislike the idea of ABM.

I do always rule out hemolytic disease as much as possible by getting
Coombs, and smear for hemolysis, type and Rh, and in the last 10 years have
only seen one ABO problem.  The rest have been pokey, sleepy babies not
getting enough calories, often in primips with milk slow to come in for
some reason, or else exaggerated bm jaundice in the 2nd 7 days.
Interesting in the native American population I see bm jaundice frequently,
and it often lasts 6-8 wks, w/ bili's of 12-14 up to that time, then just
resolves.  People are finally figuring out that these babies are fine, just
yellow, and don't need to be treated, for crying out loud.

A neonatologist recently advised me to try putting the lights quite close -
13 inches - from the baby, as well as the wallaby from below.  There were
some temp regulation problems with baby getting too warm (we had heated the
room pretty good), but solved that and the bili dropped from 21 to 13 over
night, with no ABM.  Sure goes against regulations, but it worked well, in
this series of one : - )  Have you seen any lit on this idea?

Jude


VvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvV
Jude Kurokawa, CNM, FNP-c     Only Cowards cook on low.
513 Dayton Street
Wolf Point, MT 59201 (where A Coyote midwife sits by the hole and waits...)


Mailto: [log in to unmask]         http://www.midrivers.com/~jkuro






----------
> From: Lawrence M. Gartner <[log in to unmask]>
> To: Tim and Jude Kurokawa <[log in to unmask]>
> Subject: Re: Bili lites, abm, Re: Jaundice in Breastfed Baby
> Date: Thursday, November 13, 1997 8:33 AM
>
> First, my concern is that the infant is still below birth weight at 5
days.
>  This suggests that the baby is not getting as much milk - or calories -
as
> you think he is.  Is this infant getting primarily foremilk?  How long is
> each nursing episode?
>
> In answer to your specific question:  This is part of the art of medicine
> and one must use judgement and a little trial and error with careful
> monitoring.  If the bilirubin is above 20 but less than 25 and the infant
> is tlruly healthy, thriving and of good weight, and hemolysis has been
> ruled out as best one can, then continuing breastfeeding and
supplementing
> with formula using a nursing supplementer would be one option.  The
other,
> but number two option, is to continue the breastfeeding and use
> phototherapy.  If the bilirubin is rising rapidly or is heading up toward
> 25 despite attempts to increase milk production, frequency of feeding,
etc.
> and use of supplementary formula and/or lights was not promptly effective
> (within 24 hours) then I would interrupt breastfeeding for 24 hours.
Also,
> keep in mind that there are other causes for high bilirubins including
> inherited metabolic problems, undiagnosed hemolysis, etc.
>
> I hope that helps - there are no simple answers.
>                 Larry Gartner
>
>
>
> >
> Lawrence M. Gartner, M.D.
> Professor of Pediatrics and Obstetrics/Gynecology
> The University of Chicago
> MC6060
> 5841 S. Maryland Avenue
> Chicago, IL 60637
> Phone: (773) 702-0389
> FAX: (773) 702-0764
> E-Mail: [log in to unmask]