In a message dated 4/30/01 7:37:06 PM Eastern Daylight Time,
[log in to unmask] writes:


> My daughter is very
> upset...baby has not had any formula up to now and 1st baby had milk
> allergies.  She states that even if it IS her milk she wont stop
> breastfeeding...so whats the point of this 24 hour breastmilk free
> test...other than to say hmmmm its the milk?   I told her to keep nursing
>

I agree with you Lori. If baby is getting plenty of calories & fluid via
breastmilk, I would hesitate to stop breastfeeding and give formula.
Breastfeeding by Ruth Lawrence (5th edition, 1999, pp 480-487) has some very
good information on hyperbilirubinemia and jaundice. Consider what is written
on p 485, box 14-5  "Management outline for early jaundice while
breastfeeding. . .
5. When bilirubin level approaches 15 mg/dl, stimulate stooling, augment
feeds, stimulate breast milk production with pumping, and use phototherapy if
this aggressive approach fails and bilirubin exceeds 20 mg/dl.
6. Be aware that no evidence suggests early jaundice is associated with 'an
abnormality' of the breast milk, 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."
Based on the statement in number 6, they meet all the criteria for stopping
the breastfeeding temporarily. And this doesn't even get into the positve
coombs. Not my favorite solution, but perhaps necessary in this case.

Laura Hart
Winter Park, FL

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