Down's babies with a murmur need to have an echocardiogram ASAP (even without
a murmur, they should have an echo in the first day or so of life), as the
incidence of cardiac malformation is VERY high.  Down's babies with a cardiac
lesion might have trouble feeding.

The jaundice should have been evaluated--what are the baby's liver enzymes
like?  What is the maternal and infant blood type?  Are there any signs of
hemolysis?  What is the baby's hemoglobin?  Are there any signs of congenital
leukemia or sepsis?

Down's babies have defective immunity--breastfeeding is even MORE important
for them!  Jaundice is NOT related to breastmilk in the early neonatal
period.  (It might be LACK of breastmilk if the intake isn't good.)   There
is NO REASON to stop breastmilk feeding because of jaundice.  It IS necessary
to ensure good intake.

I would have your sister return to breastfeeding immediately.  She may need
to pump to maintain good supply if the baby is not able to take adequate
volume directly from the breast.  The baby can be supplemented with the
pumped milk.

This baby needs a good cardiac evaluation ASAP.  He may also require further
testing for other problems.

The AAP website has guidelines for health supervision of Down's patients.
There are also a number of web sites devoted to issues related to Down
Syndrome.

Linda L. Shaw MD FAAP

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