Cindy
The protocol should be to treat the hyperbilirubinemia via phototherapy,
(it's been many years since I've done an exchange transfusion), while
continuing unrestricted breastfeeding. These babies are often under double
phototherapy, and therefore do have an increased risk of dehydration. Each
infant should be evaluated on an ongoing basis, as to whether they are
otherwise well, feeding effectively, and indications for supplementation.
In my experience, this is not done, rather the babies are separated from
their mothers, and the mom usually comes into the nursery every 3 hrs for a
feeding (disregarding baby's cues at other times) or the baby goes out for
30 minutes every 3 hrs. This has been my experience. Sometimes the doctor
will discontinue breastfeeding for a time, and have the baby fed formula.
This usually will bring the bilirubin down faster, although it should not be
necessary (maybe rarely).
As far as your inservice, I would suggest reviewing the Academy of
Breastfeeding Medicine protocols, some good medical refs, and run it by the
attendings. I would rather see you trying to get the practice changed of
having babies restricted from their mothers, rather than having to defend
what amounts of milk are appropriate.
I would emphasize that unrestricted access helps baby take more in, and
helps mom make more milk. Even a biliblanket could be used during the feed
so that the baby still was getting some phototherapy continuously.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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