Hi Mary, I understand what you mean, and in the general population of bf
babies I totally agree. What I am looking at is the BF baby who is
jaundiced, who is not maybe nursing as well as I would hope, the mom maybe
has sore nipples or is having trouble with latch, and to top it all off,
the kiddo is a set up for jaundice - as you mention - with a
cephalahematoma, was induced for 3 days with buckets of pit, etc.
On these kids, I think one needs to be more aggressive about wt gain and
calories, and need to work really closely with the mother to tune up the
nursing so baby can start excreting all that bilirubin as quickly as
possible.
One other thing about the magic 2 wk back to birth wt mark. In societies
where baby has unhindered continuous access to the breast, I remember
reading that the infant often doesn't lose weight at all, and within a
couple of days is actually gaining. Wish I could remember the reference.
The point is, we seldom give labor meds here, and no rubber nipples and I
rarely see a baby who hasn't regained his birth weight by the 1 week
weigh-in. The ones who don't are the ones who had a traumatic birth,
induction, csection, or some such. You can bet I watch these like a hawk,
and pay a bit more attention to the jaundice and to how the baby is
nursing.
Speaking of wt gain, has anyone noticed that really BIG birth wt babies
tend to have a little harder time gaining to birth wt? Had an 11 LB boy
from a primip who took 4 wks to get back up to birth wt .
Jude
PS: I'm enjoying these discussions and learning a lot!
VvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvV
Jude Kurokawa, CNM, FNP-c Only Cowards cook on low.
513 Dayton Street
Wolf Point, MT 59201 (where A Coyote midwife sits by the hole and waits...)
Mailto: [log in to unmask] http://www.midrivers.com/~jkuro
----------
> From: Mary A. Banaszewski <[log in to unmask]>
> To:
> Subject: Re: Bili lights, ABM, Re: Jaundice in Breastfed Baby
> Date: Thursday, November 13, 1997 4:35 PM
>
> Jude,
> Before you resort to supplementing with ABM please consider a couple of
> points; 1--A baby not back to birth weight by day 5 is not a concern.
Most
> babies will drop from birth weight for the first 3 days, by day 4 they
> typically plateau out and then by day 5 are starting to increase their
> weight. The guidelines we follow (and have never had problems with) is
that
> baby be back to birth weight by 2 weeks. 2--There may be other influences
> at play with the jaundice; was there birth trauma (bruising) that would
> explain the presence of more by products of RBC destruction? Was the
mother
> exposed to prolonged IV pitocin production? These are just 2
possibilities
> and this is all just IMHO. Thanks, Mary Anne B.
> Mary A. Banaszewski, RN, Lactation Specialist
>
> ----------
> > From: Tim and Jude Kurokawa <[log in to unmask]>
> > To:
> > Subject: Re: Bili lights, ABM, Re: Jaundice in Breastfed Baby
> > Date: Thursday, November 13, 1997 10:33 AM
> >
> > Thanks for your reply. I realize there are no pat answers, but I
> > appreciate your thoughtful response. I think I may need to have some
> > nursing supplementers on hand, as this sounds like a workable
compromise,
> > as much as I dislike the idea of ABM.
> >
> > I do always rule out hemolytic disease as much as possible by getting
> > Coombs, and smear for hemolysis, type and Rh, and in the last 10 years
> have
> > only seen one ABO problem. The rest have been pokey, sleepy babies not
> > getting enough calories, often in primips with milk slow to come in for
> > some reason, or else exaggerated bm jaundice in the 2nd 7 days.
> > Interesting in the native American population I see bm jaundice
> frequently,
> > and it often lasts 6-8 wks, w/ bili's of 12-14 up to that time, then
just
> > resolves. People are finally figuring out that these babies are fine,
> just
> > yellow, and don't need to be treated, for crying out loud.
> >
> > A neonatologist recently advised me to try putting the lights quite
close
> -
> > 13 inches - from the baby, as well as the wallaby from below. There
were
> > some temp regulation problems with baby getting too warm (we had heated
> the
> > room pretty good), but solved that and the bili dropped from 21 to 13
> over
> > night, with no ABM. Sure goes against regulations, but it worked well,
> in
> > this series of one : - ) Have you seen any lit on this idea?
> >
> > Jude
> >
> >
> > VvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvVvV
> > Jude Kurokawa, CNM, FNP-c Only Cowards cook on low.
> > 513 Dayton Street
> > Wolf Point, MT 59201 (where A Coyote midwife sits by the hole and
> waits...)
> >
> >
> > Mailto: [log in to unmask] http://www.midrivers.com/~jkuro
> >
> >
> >
> >
> >
> >
> > ----------
> > > From: Lawrence M. Gartner <[log in to unmask]>
> > > To: Tim and Jude Kurokawa <[log in to unmask]>
> > > Subject: Re: Bili lites, abm, Re: Jaundice in Breastfed Baby
> > > Date: Thursday, November 13, 1997 8:33 AM
> > >
> > > First, my concern is that the infant is still below birth weight at 5
> > days.
> > > This suggests that the baby is not getting as much milk - or
calories
> -
> > as
> > > you think he is. Is this infant getting primarily foremilk? How
long
> is
> > > each nursing episode?
> > >
> > > In answer to your specific question: This is part of the art of
> medicine
> > > and one must use judgement and a little trial and error with careful
> > > monitoring. If the bilirubin is above 20 but less than 25 and the
> infant
> > > is tlruly healthy, thriving and of good weight, and hemolysis has
been
> > > ruled out as best one can, then continuing breastfeeding and
> > supplementing
> > > with formula using a nursing supplementer would be one option. The
> > other,
> > > but number two option, is to continue the breastfeeding and use
> > > phototherapy. If the bilirubin is rising rapidly or is heading up
> toward
> > > 25 despite attempts to increase milk production, frequency of
feeding,
> > etc.
> > > and use of supplementary formula and/or lights was not promptly
> effective
> > > (within 24 hours) then I would interrupt breastfeeding for 24 hours.
> > Also,
> > > keep in mind that there are other causes for high bilirubins
including
> > > inherited metabolic problems, undiagnosed hemolysis, etc.
> > >
> > > I hope that helps - there are no simple answers.
> > > Larry Gartner
> > >
> > >
> > >
> > > >
> > > Lawrence M. Gartner, M.D.
> > > Professor of Pediatrics and Obstetrics/Gynecology
> > > The University of Chicago
> > > MC6060
> > > 5841 S. Maryland Avenue
> > > Chicago, IL 60637
> > > Phone: (773) 702-0389
> > > FAX: (773) 702-0764
> > > E-Mail: [log in to unmask]
> >
>
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