TAILIEUCHUNG - Ebook Breastfeeding management for the clinician (4E): Part 2
(BQ) Part 2 book “Breastfeeding management for the clinician” has contents: Physical, medical, and environmental problems and issues; maternal pathology - breast and nipple issues, physical, medical, emotional, and environmental challenges to the breastfeeding mother, and other contents. | Chapter 6 Beyond the Initial 48–72 Hours: Infant Challenges INTRODUCTION A number of breastfeeding problems and issues must be addressed immediately and throughout the initial hospital stay, whereas other issues may have their origins in the early days but become apparent after discharge. Some are conditions that require an ongoing need for specialized lactation support postdischarge. This chapter discusses situations that require close follow-up and intense support, including hyperbilirubinemia (jaundice), dehydration, weight gain/loss issues, and breastfeeding late preterm and preterm infants. NEONATAL JAUNDICE Neonatal jaundice is a common condition and generally self-limiting in the newborn. It is estimated that 60–70% of term infants will become visibly jaundiced—that is, they will have serum bilirubin levels exceeding 5–7 mg/dL (85–119 mmol/L)—in the first week of life (MacMahon, Stevenson, & Oski, 1998; Maisels & McDonagh, 2008). Neonatal hyperbilirubinemia increases during the hours after birth and usually peaks at 96–120 hours after discharge from the hospital. Approximately 5% reach levels > 17 mg/dL ( mmol/L; Harris, Bernbaum, Polin, Zimmerman, & Polin. 2001), and around 2% of these newborns reach a total serum bilirubin level of > 20 mg/dL (342 mmol/L; Newman et al., 1999). Estimated rates of high-risk bilirubin levels (> 25 mg/dL [427 mmol/L]) vary from 1:700 (Newman et al., 1999) to 1:1,000 (Bhutani, Johnson, & Sivieri, 1999a). Jaundice is a frequent reason for readmission to the hospital during the first 2 weeks of life (Hall, Simon, & Smith, 2000; Maisels & Kring, 1998). Most jaundice in healthy fullterm newborns is a benign condition that resolves over the first week or 2. However, extremely high levels of bilirubin (> 25–30 mg/dL [–513 mmol/L]) can be toxic to the brain, producing a condition known as kernicterus. Kernicterus involves bilirubin toxicity to the basal ganglia and various brainstem nuclei when extreme amounts of bilirubin
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