general questions to all who will listen and reply. Thanks in advance.

i have had 3 toughies in the last 48 hours.

1) baby (yesterday) 7 weeks old no spots (but real gassy, pops on an off the
breast) - mom classic thrush nipples (all was well up until 2 weeks ago).
 had a very active (heated) discussion with pedi today.  got him to write a
prescription for nystatin drops for baby.(once pedi wrote for baby, ob will
take care of mom)  but he REALLY insisted on AAP (american academy of
pediatrics) guidelines for treating babies without visible mouth thrush.
 please remember we ARE treating the nursing couple (even if pedi doesn't
think this way)  I had to use a very graphic discription of how vd (sexually
transmitted diseases)  can ping-pong back and forth if both partners aren't
treated together (at the same time) before he really started paying
attention.

my 100+ references from the new lc series on thrush were not enough for him.
 does anyone know if any AAP guideline or suggestions exist to treat baby if
mom is the only one with visible symptom's.  He's giving me 3-4 days to see
if my "voodoo" medicine will start to work.

2) baby #2 for today - 8 days old has a real positive initial test for MSUD
(maple sugar urine disease)  He looked good in the office today but wouldn't
lactch (took 1.5 oz of expressed mom's milk via cup, then went to sleep)  up
until 48 hours ago was nursing really well, 1 oz shy of birth wt by day 6 and
up another 1/2 since monday even though nursing has really fallen off.

Could breastfeeding delay the onset of symptoms?  from what little (very
little) I know about this condition, bf with tight management like pku might
work out.  Baby had another blood test late this pm.  baby may be shipped to
U of M hospital in ann arbor tomorrow.  I NEED INFO ASAP (as in yesterday)
sorry to shout.  I pulled all the old lactnet stuff already.

3) baby #3 for today - 6 days old elevated bili- 21.5 yesterday, 21.3 today.
  baby only likes the left breast - refuses  right  (mom had 2 very large
(golf ball size) benign tumors removed, at different times from underside
(when she was a teenager)).  Surgeon scraped :-( out lots of scar tissue with
the second surgery. this IS the side the baby likes.

this mom has nursed both of her other children and they both liked the right
(faster flowing) breast.

From what i saw today baby can't handle the flow from the good breast. put
baby in a sitting football hold was able to nurse (so-so) but baby acts like
he doesn't like to get a whole mouthful of breast in (looks startled - even
on the slow side). too much milk, too fast???   ANY suggestions.

baby is alert and gaining wt ok? has slowed since mom's milk came in, bili
will be done again fri.

Sorry that this post was so long. thank you in advance

Anne Norton

(the lc pharmacist)

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