I am seeking advice for a mother, G2,P2, both term babies delivered by
c-section. The first baby girl was slow to gain weight in the first 5 weeks
and had slowly fading jaundice during that time. Then she hit her stride
and took off from there. She is now a healthy, energetic two year old. Now
her baby sister is repeating this pattern. Born 2 weeks ago at 8 lb 13 oz,
she rapidly lost a full pound before discharge. This mother has ulcerative
colitic and is totally committed to giving her babies nothing but breastmilk
so that they don't have to deal with what she has endured. She does not
have an ABO incompatibility issue with the jaundice. Over the past two
weeks, the baby has been very willing to breastfeed and sleep and we worked
together to correct some early latch on issues. Sometimes she nurses well
with audible swallowing. At other times, she nurses quite inefficiently and
transfers only a fraction of an ounce. Mother took home a hospital grade
pump and is supplying her milk as a supplement. They initially used an SNS
at breast and as a finger feeder. Still her weight fluctuated under 8 lbs.
The ped. keeps setting goals of expectations; for instance, 'she has to gain
two ounces in two days or we'll have to do blood work.'
Over this snowy weekend, they took a scale home to help evaluate her
feedings. The ped. wanted them to go to the lab. for a CBC, complete
metabolic panel, bili, UA and culture. With the impending snowstorm and
their first child's experience, they considered putting off going for the
lab work for a few more days. They want to give her a full three weeks to
regain her birthweight, although that looks doubtful for her to gain almost
a full pound this week.
I have kept her ped. informed, but now I feel like I am in the middle of a
power struggle. The LC in the ped's office suggested formula supplements at
the very first visit and has reiterated that advice again. These parents
are going to try a new ped this week and see if they can get someone to help
in a non-threatening way and take seriously the mothers history of colitis.
The office LC called me and asked me if the parents were going for the lab
work and other questions that I was reluctant to share information about,
mostly because I was not certain that the parents would or would not go that
day to the lab.
The baby's jaundice is still generalized except for palms and soles, but it
has a faded appearance. They have never suggested bili lights, but she did
get some sun last week before our weather deteriorated. We are not likely
to see the sun this week. She is less sleepy now, awaking on her own and
demanding feedings. They are supplementing with at least 1 oz. of
breastmilk after each feeding at breast. She has six or more wet diapers in
24 hours and 3-4 dark golden stools.
Thank you for letting me air this concern. I would appreciate any insight
you may offer.
Diane Perrone, RNC
Materna Wellborn
Algonquin IL USA
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