Hello. I will keep this brief. THanks for the description of HELLP syndrome.
ALthough I am an RN, I am not highly experienced in OB, being of pediatric
background.

CASE: Client called yesterday. Baby 13 days old. She called for pump rental,
and LC consult. Baby born at 5'10", down to 5'2" on day 10. Bili up to 18+.
Now headed down. Throughout entire course, baby continued to have GOOD
OUTPUT< at least 5 bms and 6 wet diapers/day. This puzzled me. Baby , on day
10, cried for 7 hours. Mother called Ped. The nurse in office instructed her
to give tylenol for crankiness. Mother asked for visit. Baby had been losing
weight, then down to 5'2", and doctor advised formula adlib three times
daily after bf. Mother wanted to explore options of SNS, pumping, etc.

On exam, baby was very yellow, trunk, hands, eyes, etc. VERY small.
accordion folds of skin. Had that "look" of starving baby. Awake and alert,
weak suck. Mother had been giving 6-9 oz formula q day, with a 2 oz/2 day
gain. Sucked well at bottle. Sucked poorly at breast during consult.
Hollowed cheeks. Mother could pump 1 oz..which baby took well at breast with
SNS. baby peed and pooped during consult.

I followed with pediatrician by phone right after visit, and he asked mother
to come in for check. Mother was perplexed, and was tired...wanted to wait
till this am, but went. Baby gained 2 oz in 2 days.  I have never seen a
baby who lost dramatically while still maintaining adequate output.

Mother ok..birth good, breast changes during preg, never engorged, but baby
was audibly swallowing in beginning, but now doesn't as much, just hangs out
at breast, weakly sucking, unless SNS there.

Any thoughts?

Kathleen

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Kathleen B. Bruce RN, BSN, IBCLC
Williston, Vermont USA
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