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Subject:
From:
LuAnn Smith <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 18 Nov 2003 17:09:24 -0500
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Hope this generates some discussion among the rank and file:

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 but......

After hearing Dr. Gartner's presentation on kernicterus at the AAP,
presentation last month in Chicago, we are all very concerned when this
occurs. In "thinking outside the box", 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. We
do have an excellent policy IMHO on offering expressed mother's milk feeds
fo formula if needed in small amoutns for ineffective feeds as needed.

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.

LuAnn Smith RN, BSN, IBCLC
Wellspan Health
York, PA

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