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Date: | Sun, 16 Oct 2005 13:37:59 +0000 |
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annie,
this baby is at serious risk of dehydration and wt loss in my opinion. the
jaundice will likely increase due to poor feeding including vomiting, and
the hematoma.
(red flags from your post: vomiting, no stools today, large hematoma on her
head, does have some jaundice, Very sleepy at the breast).
if there is a blockage the vomiting is usually severe and the abdomen gets
distended and loses bowel sounds. baby generally looks very ill.
i'm even wondering if there is a neuro component to the vomiting, altho more
likely this all will resolve in several days as the baby recovers from a
difficult birth. however the baby can get into trouble in the meantime if
not protected.
recommendations:
find a healthcare provider that is really taking this seriously and will f/u
closely. this is not a baby who needs to go home and return to peds in 2
wks! i would recommend continuous kangaroo care (baby upright), make sure
mom pumps frequently w/ a top quality pump to preserve her supply, hand off
to dad when mom pumps. i agree w/ freqt small feeds but i believe in
calculating what baby needs because often i see severe underfeeding in these
cases. the physician needs to be kept closely apprised of the intake and
output and the baby may even need an i.v. for a time and some phototherapy
if the bili gets too high (i.v. not because of the juandice, but if baby
really cannot keep food down). i hope if this is the case, the phototherapy
can be done at home or if in hospital they are family friendly and allow the
famiy to be together (rare in my experience). an easy calculation i use is
2.5 ounces x baby's wt in pounds = approxmate 24 hour intake needed. divide
this into hourly feeds if necessary. (example for a 6 lbs 4 oz baby--> 2.5 x
6.25 = 15.6 oz per 24 hrs; or .65 oz per hour or 1.3 oz every 2 hrs). 2 hrs
feeding may be more manageable for all.
(you probably already know this, but others may benefit).
Laurie Wheeler, IBCLC, MN, RN
Tupelo Mississippi, s.e. USA
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