This article appeared last summer in the Boston Globe. Well done. Listen up, physicians.
Today I saw more patients than I would have liked. Felt too rushed to really listen as much as I should have. Mondays are getting to be like this.
Many new babies today. Some still inside .. some not. We see more neonatal jaundice in our office than I had seen in the past. I think it's because most of our patients breastfeed. Back when I worked in Schenectady, I rarely saw jaundiced neonates. Two flavors I see most often: Physiologic Jaundice - which usually peaks by day 3 or 4 and is often resolved by day 7, and Breast Milk Jaundice – which usually peaks at day 7 – 10 and doesn't resolve for weeks thereafter.
Another (in pdf – so this one prints well)
A Cochrane Review from 2000 on fibreoptic phototherapy. If you've never seen one of these things .. call a local home therapy equipment reps and ask them to bring one over. I hadn't seen one until I'd been in practice for several years …
A Revidw of Hyperbilirubinemia in the Term Newborn in the 2/15/2002 American Family Physician.
Several of the yellow kids I've seen recently have been delivered by local midwives, who often delay clord clamping. It seems intuitive that delayed clamping produces more RBC load — therefore more jaundice. But I haven't found much in the literature on this. This article reviews 20 years of literature and claims that the benefits of delayed cord clamping are clear. Another paper from the nurse-midwife literature reviews the beliefs and practices of nurse midwives in the US: The majority of CNMs (87%) place the baby on the mother's abdomen immediately after birth and 96% avoid clamping a nuchal cord whenever possible. Although Varney's Midwifery was cited most frequently as a reference, 78% of the respondents listed no references reflecting, in part, the absence of evidence-based recommendations for cord clamping practices.
