Hello,
Sure you are aware of different hyperbilirubinemias...
physiologic one, in the first 48hours,
then non-breastmilk jaundice, or "bad management of breastfeeding", the best
known, the worse diagnosed (many moms have had to wean because their milk
was not good, because the baby was jauniced with breastmilk, and in fact it
was a non-breastmilk jaundice with few hindmilk, few breastmilk, so the bili
could not be ejected with stools. (let me shout, cry how many women weant
without having called me or another IBCLC for counseling..... grrrr)
And there is the breastmilk jaundice, other name is late-onset jaundice or
breast milk jaundice syndrome;
So 3 jaundices...
I have information, from the excellent drs Lawrence & Lawrence
"breastfeeding, a guide for the medical profession" (6th edition p. 538)
"The late-onset breastmilk is attributed by Arias and associatiates to a
substance in the milk of some mothers that inhibits the hapetic enzyme
glucoronyl transferase, preventing the conjugaisonof bili; identified as 5
beta-pregnage-3-alpha, 20 alpha-diol .... etc"..
If you have a colleague not too far, maybe you can use her book....
But in fact, what should be done, is: ruling out which kind of jaundice your
mom suffer???? the one linked to the breast-milk (3rd one if I may give
numbers....) or the one linked to lack of breastmilk (maybe lack of good
transfer thus you helped a lot????)
Breast regards,
Tell me if you need that I type the extract from the book for you;
There was also conference about hyperbilirubinemia in Gold 09 (thru health e
learning);
Françoise Coudray
----- Original Message -----
From: "Molly Shakar RN, IBCLC" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, September 08, 2009 4:47 PM
Subject: supplementation
Dear All,
I had such a frustrating time last week and would like some assistance.
I had 3 moms, all in one week, call me after discharge confused with the
orders they were recieving from their peds office. I had assisted all 3 moms
in
the hospital and they were all doing well despite their birth experiences
( 2
had hematomas from vaccum and 3rd C/S).
All 3 were jaundice at F/U appointment at peds. One had already gained 4 oz,
1 had gained 1oz and the last had maintained. They were told to breastfeed
every 2 hours and to give 1 oz of formula to flush out the bili. The highest
#
of the 3 was 15 on day 4. All babies were feeding well, frequent stools.
They
had all come to my prenatal class and were calling me for advice.
I spend my day doing damage control!!!!!
They were all told there is an enzyme in the breastmilk that will keep the
higher levels of jaundice. One of the docs in this practice says they need
formula to create biochemical activity in the liver to rid of the bili???
Why is it
that they think it is ok to compromise the baby's gut with ABM when the
breastfeeding is going well?????
I go to lecture frequently and when I heard Dr. Newman in April he said that
babies are not jaundice because of breastfeeding because of lack of
breastfeeding.
I am going to approach this Dr. to discuss this since this is her protocol
for
jaundice and breastfeeding. I just needed to ask all of you for help as I
want
to have it clear in my head what the correct info it. ( Which I know but
need
to hear it from the wise ones) Is there really an enzyme? I don't remember
hearing that. I am going to give her the ABM protocol for supplementation
and
was wondering if there was anything else anyone would recommend.
Thank you in advance for any words of wisdom. Praying that this week will be
better than last. NOT!!
Molly Shakar RN, IBCLC
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