tell me about Jaundice

[bubbamummy]

I have heard SO many mothers say they HAD to formula feed due to jaundice. I think some of the medical profession are misinformed about this...please give me some pro's to breastfeeding through jaundice in a newborn.

[BugMacGee]

OK. I see babies re-admitted to the NICU for jaundice often.



It usually a matter of getting rehydrated and getting enough food for baby to flush the bilirubin out via urine and stool. Breastmilk is better at this due to it's laxative effect. If mom has a good supply and breastfeeding is going well, it shouldn't be a problem. If not and baby is symptomatic then problems ensue. The more jaundiced babies get, they get more lethargic and less likely to eat. Vicious circle and all.

Mild jaundice doesn't need any further treatment than breastfeeding on demand and monitoring baby's output.



If baby comes in moderately jaundiced and dehydrated, we have a couple choices, start an IV or supplement. Or both, in addition to phototherapy.
If baby is severely jaundiced, we consider a partial or double volume exchange transfusion to get rid of it quickly before there is permanent damage to the infant. This is usually due to blood incompatabilities, infection or other underlying causes. Not anything that feeding would fix.


I've seen some really severe cases lately. Babies coming in on day 5-7 realllllly dehydrated and with bilirubins through the roof! One of those babies barely woke up to take any kind of feed. He was on IV fluids for 3 days.

It is very important for mom to continue to breastfeed though hyperbilirubinemia. Those babies need every drop of breastmilk they can get.

[mrs*kewpie*pie]

just subbing but i'll be back.....

[songbh]

Some in the medical profession are misinformed about treating jaundince in the breastfed newborn. However, it's not as simple as saying, "Just keep breastfeeding." Some jaundice is normal (this is called physiologic jaundice), but bilirubin levels that get too high or stay high when they should be falling can be dangerous for the baby.

What's tricky is that the "safe" level of bilirubin changes with each day of life. When I'm helping a mother in this situation, I always go to my resources, share very specific info with her about the bili numbers we want to be seeing, and provide her with info that she can then take to her baby's healthcare provider in hopes of protecting the breastfeeding relationship while her baby gets whatever treatment is appropriate for the situation. I never treat it lightly or with a blanket assumption that she should just keep breastfeeding and all will be well. Sometimes it's not all well.

One thing that is really common in the moderate-severe jaundice cases is that breastfeeding isn't actually going all that well. If it were, the baby wouldn't have gotten dehydrated. So I think it's really important for breastfeeding mothers of abnormally jaundiced newborns to get extra lactation support to build up or protect their milk supply, evaluate the baby's latch, suck, and intake, nurse more frequently, perhaps pump and give EBM supplements, etc. etc.

[Macnamara]

Originally Posted by sophieslion

I have heard SO many mothers say they HAD to formula feed due to jaundice. I think some of the medical profession are misinformed about this...please give me some pro's to breastfeeding through jaundice in a newborn.

My LO was jaundiced when I took him home from the hospital. Thankfully ped. just told me to keep and eye on him and if he started to look more yellow, to bring him in. He never once said to use formula.

Our case might have been a little different from most, just because he wasn't as high as some babies can get. Ped. said he was a little high, but not to worry unless he turned more yellow.

[mrs*kewpie*pie]

what i understand is that although any jaundiced baby requires close observation the concern is when the jaundice begins to advance

there are 3 kinds, that related to a blood incompatability or congenital anomoly, physiologic which is related to excess fetal red blood cells and how they are broken down after birth, and breastmilk related or late onset

you'll see the incompatability or anomalous jaundice come on within the 1st 2 days of life and i'm not sure what the treatment protocols arre

physiologic jaundice will come on btw days 3-5 and can be related to underfeeding or a late start at breastfeeding, in addition to the jaundice you'll see infrequent feeds, delayed and infrequent stools

the physiologic jaundice only lasts about 10 days and i think its the kind that can best be treated by more freequent nursing

if the juandice doesn't come on until 7 days or more then its breastmilk related and may be related to G6PD, with this kind you'll typically see abundant milk and normal stools and it lasts over a month

the 1st thing to do would be to test for G6PD but keep breastfeeding, then to confirm diagnosis you'd stop breastfeeding for 12-48 hours and then resume with breastfeeding to confirm diagnosis

you'd pump and save the milk to maintain supply but feed formula during this time

the bilirubin might increase during this time but eventually will decrease so b reastfeeding can continue

if a baby is premature, has birth injuries resulting in bruising, has feeding difficullty, has brothers or sisters who had jaundice, is of east asian or meditarranean descent, has a mother with a different blood type or had jaundice in the 1st 24 hours of life that baby is at higher rsk for noticable jaundice and would bear close observation

some things that reduce risk of developing jaundice in a healthy baby include initiating breastfeeding as soon as possible after birth, skin-to-skin contact with mom as soon as possible and as much as possible, making sure mom knows what feeding cues to look for and rooming in

phototherapy and exchange transfusions are treatment options for advancing jaundice

and sitting in the sunlight can also help though modern windows don't let in the right kind of rays and i don't know how easy it is to take a baby outside while you're still in the hospital....

heres a few links too

http://www.drjacknewman.com/help/Bre...20Jaundice.asp

http://www.childliverdisease.org/upl...ce_Prot_07.pdf

hth

[beru]

I had a friend whose baby had mild to moderate jaundice levels. Her doctor said, I see breastfeeding is going well so just keep going and watch her for sleepiness, etc. Sounds great, right? However, the nurses harrassed her and convinced her to give the baby a couple of bottles of formula. They completely guilt-tripped her and wore her down by telling her it was dangerous and she had to protect her baby.

[haurelia]

I think the "have to give formula" stems from ignorance and fear.

My baby was born at home, and admitted to the NICU at a week of age with severe jaundice (his bili was 26 when it was finally measured at his week visit ).
He was born at 36 ish weeks, and he wasn't nursing well at the start; my milk was very poky about coming in. He started getting yellow at 2 days old, but didn't have a bili measured until his one week visit. The deck was kind of stacked against us, but our pedi is very liberal and wanted to honor our wishes, so we weren't supplementing with anything other than the milk I would pump after he nursed. I wasn't getting a lot out, but also didn't really realize that my baby wasn't tranferring a lot of milk. He pooped and peed as expected, so it was kind of hard to tell.

When we were admitted to the hospital, I emphasized that we wouldn't accept formula unless medically necessary. The MD team agreed, and said that breast milk was the best thing for him anyway. Turns out that in addition to having very little actual milk transfer going on which lead to dehydration, we also had ABO incompatibility which accelerates the red cell breakdown and exaggerates that physiologic jaundice of a newborn. He was treated with triple light therapy for 3 days and had IV hydration for about 16 hours.
So-called "breastmilk jaundice" is totally harmless to babies and occurs later in life (like week two) than physiologic or blood incompatibility jaundice. Either way, there is no evidence that breastfeeding should stop (the Dr Newman link that Mrs Kewpie Pie posted is an excellent resource).

We did end up supplementing with some donor breastmilk for the next two weeks, as he had also lost a bunch of weight and I was still tanking up my supply.
Anyway, there is NO reason that I know of that breastfeeding should stop with jaundice. There may be some indications to supplement feedings, especially if the baby is on phototherapy for a long time (because it can lead to dehydration), but I would prefer that my baby have IV fluid over drinking formula.

[slinginhipmama]

All three of my boys were jaundiced, all three were put under "the lights". Not one took formula because I researched it, had hand-outs of info to give to medical staff (even in the NICU) and demanded to supplement ONLY with my pumped milk.

[slinginhipmama]

Originally Posted by haurelia

Turns out that in addition to having very little actual milk transfer going on which lead to dehydration, we also had ABO incompatibility which accelerates the red cell breakdown and exaggerates that physiologic jaundice of a newborn. He was treated with triple light therapy for 3 days and had IV hydration for about 16 hours.

We dealt with this too! I totally agree with your whole post!!! It is out of fear and ignorance that formula is recommended.

[lrgs]

I know when my baby was born she was jaundiced and had to have light therapy. The nurse (who I dislike to this day) was concerned because she'd only had 3 pees since birth and this was about 24 hours afterbirth. I was doing some Jack Newman reading recently and saw that it is normal for a newborn baby to have one pee on day one, two pees on day two, three on day three. However, I was a new mom and wasn't very informed so obviously I was concerned (needlessly) because this nurse was concerned. She told me I had to start supplementing. Luckily, I knew about nipple confusion and I said I would only give sugar water by syringe. She made me feel like I was totally ridiculous and silly for not bottle feeding formula. I only gave 20mls of sugar water just before discharge and I was sent home with lots of sugar water and instructions to supplement after every feed. Luckily, I had an awesome doula who suggested holding off on the sugar water and bfing as much as possible until midnight (and then see how things were going). Sure enough, my milk came in a few hours later and my baby was pooping and peeing like crazy and everything was fine. I often think about how close this nurse came to sabotaging my nursing relationship with my baby. I think my situation was a combination of new momness (a word I just made up) and an uninformed nurse passing her misinformation onto me.

[wetcement101]

DD was born a month early and jaudiced. The nurses kept floating around asking if I wanted to "supplement." I said no, assuming they meant formula. They finally brought in a breast pump, which I used for a month until she was able to nurse full time.

[bubbamummy]

Part of the reason I asked is my son developed jaundice on day 2, he was lathargic and peeing bright orange pee. But NO ONE seemed concerned. He barely nursed and apart from meconium he hadnt pooped at all by 8 days old! They just told me 'keep on breastfeeding' It was horrible, he looked like a Simpson!! I began pumping as his sleepyness was increasing daily! by 10 days old I pumped and fed it to him and he guzzled down-he was still somewhat yellow at 4 weeks old!!! wow...I hope I havent damaged him ...he's one now and seems ok though!!

[Mama25]

Originally Posted by sophieslion

Part of the reason I asked is my son developed jaundice on day 2, he was lathargic and peeing bright orange pee. But NO ONE seemed concerned. He barely nursed and apart from meconium he hadnt pooped at all by 8 days old! They just told me 'keep on breastfeeding' It was horrible, he looked like a Simpson!! I began pumping as his sleepyness was increasing daily! by 10 days old I pumped and fed it to him and he guzzled down-he was still somewhat yellow at 4 weeks old!!! wow...I hope I havent damaged him ...he's one now and seems ok though!!

It is very high numbers that cause damage.

[Vaske]

Originally Posted by songbh

One thing that is really common in the moderate-severe jaundice cases is that breastfeeding isn't actually going all that well. If it were, the baby wouldn't have gotten dehydrated. So I think it's really important for breastfeeding mothers of abnormally jaundiced newborns to get extra lactation support to build up or protect their milk supply, evaluate the baby's latch, suck, and intake, nurse more frequently, perhaps pump and give EBM supplements, etc. etc.

This. It is exactly what we needed when my daughter was re-admitted for jaundice, and it is exactly the opposite of what we got from the hospital. Luckily I had other resources to help pull our breastfeeding relationship out of its nosedive afterwards.

[shelbean91]

ds1 was readmitted at 10 days old for high levels. I supplemented by pumping and feeding that way- as he was under a double bank of bililights, had an IV and they didn't want him out. He was in the hospital for 3 days. So, it wasn't that breastfeedign was the problem, it was that he wasn't latching/sucking properly to get to the milk. It took him 4 mos to learn to nurse properly.

[bubbamummy]

Originally Posted by Mama25

It is very high numbers that cause damage.

They never tested his numbers-its much less common in the UK