Ladies:
I need your help again, please. (permission to post) baby had Ped visit
today, where CBC, hepatic profie, and urinalysis were ordered Stat. Mom
reports that CBC and hepatic profile were within normal limits, but that
urinalysis was 'botched' and so baby was recatheterized for urine sample-no
results yet. Ped believes baby may have UTI. Bili level was at 20 today, up
from 18 two days ago, and weight was given as 7#9oz, up from 6#11oz, two
days ago. Mother indicates that Ped ordered her to continue bottlefeeding
Pedialyte after EVERY attempt to breastfeed. Isn't this much pedialyte
potentially dangerous, especially if milk intake is limited? Mother has
been following Ped's orders and although she is still BF, I have to
question milk transfer when baby sucks down 2 or more ounces of pedialyte
at each feed. My thought is that he is not transferring milk effectively,
since introduction of bottle, and, of course, mom cannot find the time to
come for a return consult with all these Ped visits.
What in the world is going on with this poor little guy? The fact that he
weighs 14 ounces more in 48 hours is suggestive that he is severely
constipated; if so, no wonder the bili level is increasing. Amd why are
they looking for a UTI? Could someone explain the connection to me? Mom
reported that baby was voiding well two days ago. I am most concerned, as
this baby cries, nonstop, every time I am on the phone with mom. Something
is clearly wrong, yet today's reports all came back WNL.
Mom was, at least, sent home with portable bili light, so baby has not been
separated from her, but if this condition is serious, shouldn't baby be
hospitalized? Clearly, I am out of my limits on this case, and desperately
searching for answers to all my questions. I fear that mom is loosing
confidence quickly, and has no clear answers or diagnosis yet. I have
encouraged her to dialogue with the baby's Dr., but evidently, she feels
powerless to do so, and the Dr. has not communicated with me. Perhaps he
took offense with my report, perhaps he is simply too busy.
Please, can anyone make suggestions that will enable me to get back in the
loop? I feel that I am unable to assist without the medical details I am
lacking. Have I crossed any boundaries by asking for clarification? If
mother is unable to ask the Ped for this information, how am I to obtain
it? What is the proper role of an IBCLC in this situation?
Niki Konchar, IBCLC
no longer in the space between mom and Ped, and haunted by baby's crying
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