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Date: | Mon, 23 Oct 2000 20:36:06 -0400 |
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Dear Linda, I hope you've had a chance to calm down. Had baby lost a lot
of weight by discharge? (dehydrated at discharge?) Were baby and mom
separated a lot in the first few days (baby didn't get enough chance to
breastfeed). Is there a blood incompatibility problem? (more hemolysis?)
I don't think many would argue that the baby needs lights at 21.8. You can
argue tho whether or not BF needs to be totally D/C'd. In a 1993 article
Dr. Martinez, Maisels and others said that "If the infant is significantly
jaundiced and a decision is made to intervene, parents can be given a
number of options and can make an informed decision regarding which, if
any, intervention they prefer." Pediatrics 1993;91:470-473. They used 4
methods on babies >17 mg/dL. 1) continue BF and observe. 2) discontinue
BF, substitute formula. 3) discontinue BF, substitute formula, administer
phototherapy. 4) continue BF, administer phototherapy. 3 & 4 were better
than 1 & 2. 3 was best, but none of the results were strong. But
certainly breastfeeding and single (or double) phototharapy is a valid
option.
The authors really stressed the fact that it is THE PARENTS CHOICE after
offering options, to make a choice of treatment. Now I grant you that is
a very odd notion in the US, that parents can help pick and choose and
direct their baby's therapy, but there it is in Pediatrics in black &
white by respected authors!
Sincerely, Pat in SNJ
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