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
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