I received the following email from a pediatrician here in California. I
don't have my Ruth Lawrence on hand, and Riordan did not give me enough
information. Can the doctors and other knowledgeable people on lactnet
comment on this?

Thanks,
Lisa Marasco
Santa Maria, CA


I received a call from a nurse who is part of the
NB Screening for the State on a baby who was 6 days old at the time.  The
result was questionable and needed to be repeated.  The nurse advised to
contact the mother and to tell her to stop breastfeeding and give one of the
soy formulas.

Well I contacted the mother and told her that the baby needed a repeat blood
test and asked how the baby was doing.  She was breastfeeding and the baby
was doing fine - no vomiting, no jaundice, no symptoms of any kind.  Since
the baby did not have any symptoms by 6 days of age, I did not tell her to
stop the breastfeeding, and just told her to come to be seen after the blood
test was done.

Well in the meantime this NB Screening nurse had contacted the patient and
told her to stop breastfeeding.  The next day, before the results of the
blood test were back, the baby started vomiting.  I checked the baby out,
and
determined that the baby was having formula intolerance.  The vomiting
persisted over the next 2 days.  We got the results back and it showed that
the baby was a carrier only and therefore would not have any signs/problems
of the disease.

This was a highly motivated mother for breastfeeding and she did not
understand why she had to go through all this fooling around with the
formula.

So the question is, is the State's guidelines too rigid?  If the baby does
not have any symptoms, why can't the mother continue breastfeeding until you
get the confirmatory results back?  The real question is (and I don't know
the answer yet), if a baby is born with galactosemia, how long does it take
for the galactose to accumulate to toxic levels and cause damage?  Since
this
is such a rare disease, I have never had a patient with galactosemia.

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