The exception to "feed the baby" is when there is strong suspicion of hypernatremic dehydration. During starvation, the infant body breaks down fat to produce chemicals called ketone bodies. These ketones provide both an alternate fuel for the brain, and have a high affinity for water, preventing the brain from dehydrating. This is why a breastfed infant who is dehydrated is not going to look it until he is in very bad shape. (Any formula given seems to disrupt this protective ketosis process. Patricia Drazin can tell you more about this, its something she researched). Anyway, when a lot of volume is given to a baby in hypernatremic dehydration who has a lot of ketone bodies in his brain, the ketone bodies are going to attract the water in to the brain cells and they are going to swell. Swollen brain is NOT a good thing, because there is nowhere to go in the hard skull. Increased intracranial pressure reduces blood circulation and does mechanical damage as well if unrelieved. Generally, if I see a starving, lethargic baby, I give a small volume of manually expressed colostrum or milk (when baby is in that shape, there only is a small volume available) and send him off to the hospital, with a "heads up" call to the pediatrician. If the baby is alert and somewhat active, it is unlikely that the starvation is severe, and that there is an elevated sodium level and severe ketosis, and I'd give more food, and notify the pediatrician with a request to please see the baby immediately. When jaundice and starvation coexist, the enterohepatic recirculation of bilirubin increases. In other words, the baby takes back that bilirubin that he worked so hard to congugate and excrete back from the gut, rapidly increasing the bilirubin levels. Generally plasma proteins fall during starvation, so more bilirubin is free and potentially available to pass the blood brain barrier. Most of the recent cases of kernicterus have been due to health care professionals not taking significant jaundice seriously enough. I'm very concerned about this baby, and the way the mom was treated by the emergency room triage nurse. Unfortunately, I've seen babies with hypernatremic dehydration and babies with bilirubins in the 20s and 30s. In these cases, rapid action is necessary to save the baby's life and neurological health. Catherine Watson Genna, IBCLC NYC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html