Once saw a baby who was very lethargic and very yellow and scrawny, had not 
cued to feed in 12 hrs or more, as I recall.  Even though the mother was 
given education and written info about red flags to call in about, she 
waited. I did feed the baby, he was able to suck. Sent to ER and bili level 
came back in the 40's. The baby died and I never did find out the reason, an 
autopsy was done to rule out metabolic problems.
Do get these kids to the ER if a qualified healthcare provider cannot see 
them right away. Babies can present with metabolic problems, heart problems, 
infections, etc that is not showing up yet in the hospital right after the 
birth.

With babies who are not stooling in the early days, which usually goes right 
along with not gaining, I fax my report to the m.d. stating something like 
"in my experience, this lack of stooling is a strong indicator of low milk 
intake....." "pre/post feeding weight confirms this with 11cc intake...." Or 
you can even say "while it is not unusual for babies > 1 month old to have 
this stooling pattern, in my experience, low stool output in a newborn is a 
red flag for low intake...."
you get the idea.

I would like to thank Crystal Stearns and any of you who participated in the 
Book Recovery for disaster-affected LCs. I was a grateful recipient of some 
wonderful books, which I am using at my new job in Mississippi.

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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