Wise Ones;
Please help me out. I have a client (permission to  post) w/a 6 day old (40 
wk) baby. 7#5oz at birth, 6#9oz low point(at day 5-8.5%loss), 6#11oz today 
(day six). Mother overheard Ped telling nurse that dyad had a "blood 
incompatibility"-she states that she is O+, baby is O-, but there was no 
transfusion or discharge instructions given to mother regarding Rh 
incompatibility. Baby's bili level was 12 at 72 hours, and then 18 at 144 
hours. I know that these levels are not considered dangerous for the 
healthy newborn, but am having difficulty translating the risks for an 
infant with hemolytic disease. I understand that the AAP guidelines do not 
apply to pathological issues.

I was unable to find information in either Riordan or Lawrence, but did 
locate some info in Black, Jarman, and Simpson. I am concerned that this 
info is dated 1998. The management guidelines for Rh incompatibility 
include phototherapy/exchange transfusion/ administration of Rho(D) immuune 
globulin to Rh- mother. This mother is Rh+ and the baby is Rh-, so this 
obviously does not apply. Surely, a transfusion would have been given if 
the baby needed one.....Is this still a possiblily at 6 days, or do the AAP 
guidelines for healthy babies apply??

I am reluctant to show my ignorance by suggesting that the Ped reconsider 
his order to feed Pedialyte in this situation. I suggested that the mother 
increase the frequency of feeds, waking the sleepy (and non-stooling) guy 
every 90 minutes to 2 hours instead of allowing him to sleep for 3-4 hours. 
I gave her a very basic explanation that breastmilk has a laxative effect 
and will help her baby clear the bilirubin by increasing the stools. 

Can one of you wise ladies PLEASE clarify for me how the Rh factor figures 
into the process when the mother is + and baby is -? 

Niki Konchar, IBCLC
clearly, in the weeds on a medical issue, but still attempting to keep this 
mother confident enough to continue exclusive breastfeeding instead of 
Pedialyte feeding by bottle

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html