Okay, so I am doing as you say the AAP suggests. Actually, on a gaining,
vigorous but pumpkin yellow bf baby, I don't usually even check the bili
unless ABO worries. Why ask for trouble.
The weight I watch closely, and weigh at 3 and 7 days. At 3 days I figure
the kid is at the nadir, and if real low will check on the latch, ask about
frequency of bf, pees, poops and so on every other day. Luckily I am in a
place where I can do this, and am an CNM/FNP w/ admitting priv. etc. My
guidelines are that I admit POORLY FEEDING babies with bili > 17 by 3 days,
or > 20 for adequately feeding babies (that for some reason got a bili done
- often a well meaning lab person who "thought the baby looked yellow and
knew you would want to know" .... ARRRGH)
So I have a kiddo at 4-5 days out who is nursing OK, but weight is still
below Birth wt, and has bili over 20. I watch the latch and that is
correct. Nursing at least ever 3 hrs. 4-5 wet diapers and poops. These I
admit for lights, and then my backup ped wants to stop bf for 24 hrs.
Makes me CRAZY! I have her cup feed the ABM and I have her double M____la
pump, but it puts so much stress on the dyad.
I've read a lot of lit saying in healthy bf baby (no ABO, no Rh incompat.,
not a set up for sepsis, etc) that one should just let her bf and use the
lites (we use overheads and the biliblanket simultaneously) and watch
closely for under 20. But the info is much less clear on the > 20 neonate.
Now after all this perliminary babbling, this is my question: What is the
point (if any) where a seriously bf supportive pediatrician would consider
taking the baby off the breast (assuming the milk is in and dripping) for
a day or two due to high bili???? Dr. Jack?
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:
> Subject: Jaundice in Breastfed Baby
> Date: Wednesday, November 12, 1997 10:01 AM
>Snip<
> breastfeeding is also suggested, but none of these therapies would be
> indicated in a full-term, healthy infant older than 72 hours unless the
> total bilirubin reached or exceeded 20 mg/dl. At younger ages the
> guidelines in the other table in the article would apply to the breastfed
> infant as well as the artificially-fed infant. This AAP Practice
Parameter
> is an official guideline from the American Academy of Pediatrics and is
> fully documented with references.
> snip<
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]
>
|
