Sharon, thanks for good info on bili and juandice. Ruth Lawrence's 5th ed,
1999, p.485, box 14-5 says:
<<be aware that no evidence suggests early juandice is assoc. with "an
abnormality" of the breastmilk, so withdrawing breast milk as a trial is
only indicated if jaundice persists longer than 6 days or rises above 20
mg/dl or the mother has a history of a previously affected infant.>>
Nancy, would you think this is saying that the interference with conjugation
does not occur with early milk nor colostrum?
As I read on, I have to stand corrected from a previous post about
breastmilk unconjugating bili. It is my understanding that breastmilk does
not necessarily unconjugate (more correctly stated as deconjugate) bili but
that it can 'inhibit the hepatic enzyme glucuronyl transferase, preventing
the conjugation of bili', p 486.
also note, "the undisputed cause of breast milk juandice continues to elude
investigators." p 486.
Substances that are implicated include a breakdown product of progesterone
and an isomer of pregnanediol, certain lipases, and free fatty acids. p 486.
Complex indeed. And it behooves all not to take the situation cavalierly
(not implicating anyone), as I certainly do not.
Just to remind everyone of the reason for the discussion, though, that I had
pointed out that some babies at my hospital are being kept in hosp after
their mom's discharge at 2 or 3 days of age, for bili levels of 11, 12, 13
and they are taken off bf completely for the time, or suppl. with formula,
even tho they are term well babies wtih no other risk factors such as
infection, prematurity or blood type issues. These babies are also under
phototherapy, often 2 lites. This seems a bit overzealous. The main reason
for the exaggerated jaundice, IMHO, is first and foremost mother/baby
separation with most first bf taking place from 9-24 hrs after birth,
well-meaning staff trying not to suppl at that point so giving only sips of
GW, and secondly staff not identifying and fixing ineffective feeding when
it does finally begin.
I guess someone could argue for formula as the best treatment, and someone
could argue for bf as the best treatment, it depends on at what numbers you
start to get nervous at. If I am to make a case for less interference with
bf I wanted to know if their was a good reason to use formula. I do see the
point of formula in some scenarios, but with the scenarious I am mostly
seeing, I feel the risks outweigh the benefits.
I welcome more discussion. This is not a clearcut thing.
Laurie Wheeler RN MN IBCLC
New Orleans LA, USA - 65 degrees F and still gardening
_________________________________________________________________
Join the world’s largest e-mail service with MSN Hotmail.
http://www.hotmail.com
***********************************************
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
|
