It has been a difficult few months. The JCAHO sentinel event was a focus on hyperbilirubinemia. At the hospital where I work, this means that many babies are checked several times in the first day, at certain hours after birth, and if their bilirubin is above the recommended level, then they are at risk for higher hyperbilirubinemia and need to be watched carefully. That is what the guideline says.
What this has been interpreted by many of our physicians is that babies who are over the number on the chart need to be supplemented with formula. Many days, every baby I see is being supplemented for hyperbilirubinemia. Their bilirubin may be 8 or 9, and they are also on a bili-bed. Many of them are not even vaguely looking yellow yet.
I feel they have decided that if the baby is at any type of risk at all, then they will nip that in the bud. However, breastfeeding goes downhill because now the babies want to eat a lot less often. Mothers are worried that their babies are ill. Breastfeeding seems like an evil problem that will make their babies sick.
We have to start moms pumping because their babies nurse infrequently, so that they will hurry and get their milk in. Some of the mothers are told that they will need to supplement along with breastfeeding for at least a week. If the bilirubin truly does go up to say, 17, then the babies are not allowed breastmilk anymore. At all. Mom may have lots of milk, but she is to pump it and give the babies only formula for two or three days. All of this before the baby is a week old. 
Yesterday a physician told parents that if they didn't supplement their 12 hour old full term baby, whose blood sugar was 42, then she would have to go into intensive care. No mention of trying to get her awake to feed more. No mention of expressing milk for her. The parents were so frightened. 
Can you tell I am frustrated right now? I am really finding it difficult to speak, since I have bitten my tongue so much it is about chewed off! 
Thanks for listening. I am open to suggestions, just not sure how I can use them. 


Ann Calandro,RNC, IBCLC


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