I desire feedback on the following case. Hope I have everything here: Baby born 4/20 p.m., birthwt 7lbs 0oz. [please note baby born over the 3 day weekend, due to Good Friday holiday, with no LC coverage, unfortunately]. Birth and BF uneventful (? about the bf). Discharged not quite 24 hrs old, looking jaundiced, and bilirubin level 13.9, discharge wt 7lbs 0 oz (no wt. change). Discharged home on home phototherapy tx (wallaby blanket) and instructions from MD to feed the baby every 2 hrs; the baby is bf then complement with ad lib formula, then only formula feed the next fdg. So she was BF every 4 hrs, and no instructions to express. AAAARRRGGGHHH. Ok. Mother and grandmother have spherocytosis. I look this up and it says hemolysis leading to chronic anemia and jaundice. So I figure this is the probable diagnosis and feeding is not an issue. So I am making a followup phone call but baby is being admitted to hosp at this point with a bilirubin level 25. Wt at peds is 6 lbs 9 oz [4 days old today]. Mother reports 6 stools per day, now up to 20 per day, very dark in color. I ask to see baby and observe the bf; baby has slightly dry lips, slightly decreased skin turgor, very very yellow color, I confirm his wt at 6#9, and observe a bf. Very lethargic, not robust at all, arms hanging at sides, mom using a very poor positioning and latch. I show how to improve this but baby still feeds very poorly; I did a pre and post wt and zero milk transferred [I would have guessed about 20cc]. Mom has ample supply and good MER, can pump 3 oz each breast when does not feed (even with a little battery pump}. So I recommend the cardinal rules of feed the baby, and preserve the suppply: regular expression, Q 2-3 hrs with double setup on classic pump, and feed the ebm to baby if no good bf [no need ever for the formula, duh] til he gains wt and strength. He could be dry due to the phototherapy. But I feel there is some "poor fdg jaundice" superimposed over the initial high bili which I feel is pathologic jaundice. Coombs negative, group B strep negative mom, spherocytosis test on baby supposedly negative according to mom. Any comments? Neonatologists and pediatricians? Laurie Wheeler, RN, MN, IBCLC Violet Louisiana, s.e. USA ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at 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