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Subject:
From:
laurie wheeler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 8 Feb 2004 19:46:12 +0000
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Christine, you wrote "We had a 38 week, 7 lb. 6 oz.
healthy baby boy who had a bili of 17.4 on 2nd day. Nurse said she wasn't
suprised because baby had a large bruise. Breastfeeding was slow on first
day, but mom was very patient and as usual things picked up by second day.
Baby was stooling well from birth. I watched baby at breast and heard
swallowing. I was told baby was to be started on lights (we have the Medela
bili bed)."

I don't have the AAP guidelines in front of me but they are a good place to
start. They describe what levels of bilirubin, at what ages, and for term vs
preterm infants, would warrant therapy and what kinds of therapy. This
infant's level seem high for day 2. Levels high at less than 24 hrs indicate
pathology. Levels normally peak at day 3-4. The baby may have had a blood
incompatibility which leads to increased bili levels (would have had a blood
test for Coombs positive or negative), in addition to a large bruise this
would add to the problem. Slow feeding may have contributed a little as
well. In any case, the bf should be optimized, and milk expressed is needed.
If the bili is being treated (overhead lights can be used, often 2 are used,
or bili blankets or bili beds.) then the baby can continue to bf ad lib or
preferably encouraged to bf very frequently. Dr. Jack Newman has a great
chapter on jaundice in his book and he feels bf should not be interrupted. I
agree.

In the AAP guidelines there are options and some of the options are to
supplement. The doctor makes the call. I see many babies who could surely
have continued bf w/o formula as long as they had the light therapy, but
were taken off the breast anyway, and even off ebm. The doctor decides what
levels he/she is comfortable with and when he will start therapy. We have
one peds practice that will not d/c a baby if the bili is at or above 10
(even on day 3). They keep the baby under lights (the mom goes home) and
re-check in 24 hrs. If it was 10.9 and goes down to 10.2, the baby stays
another 24 hrs. This is not consistent w/ AAP guidelines but the physician
is not bound to practice w/i the guidelines.

I am amazed that I see many physicians who do not seem to understand
physiologic vs pathologic jaundice and the relationship to bf, if any. Many
nurses don't understand it either.


Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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