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]
>