LuAnn writes;
>>We have had a steady influx of these "slightly underdone" babies lately, 
and
the subsequent jaundice that most often occurs. While some physicians treat
them appropriately, ordering phototherapy for sluggish feedings and
increasing bili's, others prefer to wait it out even with serum bilirubins
of 19 0r 20. Often these parents are home with these babies who are clearly
unable to feed vigourously at breast and somtimes even by botlle. Luckily we
have good outpatient f/u for breastfeeders
I know in our NICU, our neo's start
photherapy even for the 33-34 weeker almost prophylactically at very low
bilirubin values. those babies admitted to newborn however, never get this
treatment and are always treated after it becomes a significant problem.
For some of you MD's on the list or even hospital based LC's, are any of you
seeing a return to earlier treatment of jaundice in these near term infants
who are coming at us in ever increasing numbers?  Can anyone think of any
reason NOT to treat these little ones fairly early on, especially if it can
be provided in the home setting through a bili blanket or wallaby unit.<<

Much has been written in the past about this disparity in approach ie. given 
the same 34 wkr-approach to care would be very different in the normal newborn 
nursery vs NICU. As with alot of things, an approach somewhere in the middle 
would be nice! 
 As a hospital based LC at a large maternity hospital with a NICU bursting at 
the seams, we have many "borderline" premies on our floors.   With the 
"sentinel event" notice   I expected to find a greater focus on jaundice but it 
wasn't until the hospital inserviced the nursing staff with the recent video (I 
don't know where it comes from but my assumption is the active parent group had 
a hand in it) that I noticed a change. Now more babies are having blood drawn 
for testing but I have not noticed more treatment. Phew, so far so good. My 
fear was that the sight of jaundice would again prompt HCPS into a knee jerk 
reaction of routine supplementation, particularly if the milk isn't in yet. I say 
*again* because those of us who have been practicing RNs for many years 
remember the not so distant past when jaundiced babies were routinely supplemented 
and treated at much lower serum levels.
Although sometimes in need of it, I do have concerns with a generally more 
aggresseive approach to treatment with the near term infant   as *some* of these 
babies do well from the start or *take off* with a little extra time and 
skilled management . In terms of hyperbili management, recent technology (bili 
beds ETC) has allowed for less restrictive forms of treatment BUT routine early 
treatment would REQUIRE more mother baby separation which we know in itself 
leads to more supplementation and subsequent breastfeeding failure.

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html