When is jaundice a concern? - Page 2

[Lisalee2]

Both my dd & ds had jaundice for a short period. I don't think it was more than 2 weeks. At first I noticed it in the whites of their eyes and at the midwife's checkup, she looked at the rest of their bodies. She said it was just a mild case because it didn't spread lower than their faces. She mentioned that once it hits their chest / legs it may be more serious.

Not too much help, but just wanted to share my jaundice tales!

[Henry's_Mamma]

My ds had blood incompatibilty jaundice (I''m O+, he's B+). What happens w/ this type of jaundice is that sometime during pg or l&d, mom & baby's blood mix. If mom has O blood, her body produces antibodies to the A or B blood of her baby and then passes those antibodies to her child. The child's body responds by rapidly breaking down red blood cells until it can rid itself of the antibodies. The by-product of the red blood cell breakdown is bilirubin, and b/c the baby's liver is still kicking into gear, it can't handle the overload and jaundice appears. This type of jaundice can be very severe and can happen very rapidly (my ds was under the lights within 30 hours of his birth -- drs. were concerned b/c of the rapidity w/which his bilirubin levels were increasing). If allowed to progress, jaundice (i.e., high bilirubin levels) can cause brain damage, but it would have to get pretty bad. The other risk w/blood type incompatibility is anemia if too many red blood cells are broken down. Anemia is dangerous in a newborn (red blood cells carry oxygen and oxygen is very important to maintain bodily functions and temp.), and on occasion, blood transfusions are necessary.

My ds was very alert after birth. By the time he went under the lights he was lethargic and wouldn't eat/nurse (the change was dramatic). We had to strip him to his diaper to keep him awake to eat, and we only had 30 minutes in which to feed him, every 3 hours for almost 3 full days. He was quite sick.

The reason supplementation w/formula is often pushed (esp. if your milk hasn't come in -- mine didn't come in for 6 days despite trying to bf ds and pumping) is b/c dehydration is a common complication (those lights are hot & drying) and by getting food & fluids moving through baby's system, you help the liver to start working better and encourage a bowel movement & urination, which gets rid of a lot of the waste (bilirubin). It was more important to me to get my ds healthy and home than to worry about a few days of supplementation ... it did make a huge difference for my ds.

HTH!

[Greaseball]

Good thing dh and I are both O+. Sounds like we don't have to worry about all this.

[3_opihi]

My sons had ABO incompatibility as well. They are also part asian and I have heard that jaundice is very common in newborn asian males.

First baby had really really bad jaundice. He was orange like a carrot. I believe his levels were something like 22. He went under the lights, but we thankfully got to use the home one. I believe its called a Wallaby. It was really great. He was under the light, but still co-slept and breastfed. I suppose I was lucky because nobody ever even metioned giving him formula. I also think his jaundice risk was greatly increased because we used pitocin. Everyone I have ever talked to that had pitocin in labor, has had a newborn with jaundice. In fact, I'm going to start a thread on that right now.

Second ds was pretty orange too. But he never got sleepy and was nursing fine. I never got his levels checked because I figured as long as he was getting lots of breastmilk he would be fine. Coincidentally, I was still nursing older ds, and I wonder if me already having milk in my breasts helped to flush his system.

Greaseball, I think your baby will probably be ok. If he/she does get jaundice and they want to put him/her under the lights, just make sure you get the Wallaby. It doesn't need to be in the hospital.

[Melaniee]

Our ped did lights at 20 (unless a baby's numbers were ascending rapidly and were likely to exceed 20 if he waited another day). Ds got to 18 before my milk came in and they stabilized and decreasted.

I've seen opinions to the contrary and he felt the bili blanket was almost useless. Unfortunately Ds was born during an early-cold week and it was cloudy so we couldn't get him much time outdoors or by the window without clothing.

We have ABO incompatilibity (and pitocin...hmmm...thinking of that other thread). He was sleepy from the start (we were separated during that alert-after-birth time when BFing is recommended to start), so that was even harder. I had LATCh problems so the last thing I wanted to do was keep him at teh breast all day (OUCH OUCH OUCH), so my milk was slower to come in. I guess I'll know better next time, but his being separated was not exactly voluntary. The NICU team felt he wasn't breathing easily.

[ManyPeoplesMama]

A lot of people I know ended up giving up nursing because of jaundice, but out of 7 babies, all of mine have had it and some were quite yellow. It never occurred to me to stop nursing them. Man, I am glad I stay away from doctors. They give bad advice.

[Melaniee]

I must say that when we asked our ped (in desperation trying to avoid the lights), "Isn't there ANYTHING else we can do?" He said, "Well, there is one but you prob. wouldn't want to do it...give formula." Of course we didn't but he gained some respect for not even bringing it up until we begged.

[tarahsolazy]

Jaundice is a little tough, because, like many eloquent posters have noted, it is very common, and is often harmless. I am a pediatrican, soon to be neonatologist, so I treat this all the time. The jaundice that occurs due to blood group incompatibilities is just as a PP said, mom gives baby antibodies that break down baby's blood cells, and jaundice occurs. This type usually happens sooner (like in the first 24-28hrs) than the physiologic kind (3-4 days). I agree that in general, a jaundiced 4 or 5 day old who is feeding well, peeing and pooping several times a day, is in no danger. However, a baby jaundiced in the first day or two, or who is jaundiced to the legs, or who is really sleepy, not feeding, peeing, pooping, etc, should probably be checked. The danger is rare, but its irreversible brain damage from bilirubin staining the brain tissue. Light therapy, and (rarely needed), exchange blood transfusions, can prevent that. However, there is no need to give formula during phototherapy, breast milk works just great, anything to get those little bowels working. At my hospital, we encourage nursing, or, if the baby is too sleepy or can't latch, we will offer tube feeds of mother's milk, if the parents prefer. Or gentle use of IVs, in the case of a truly dehydrated baby. A baby who has been jaundiced for more than a week or two, even if healthy, should also have some blood tests, because some liver diseases (biliary atresia, etc), can present this way, and early treatment is better. One of the best things these days are transcutaneous bilimeters, which can check the bili using light, without a heel poke. Hopefully, these will become the standard, they are pretty accurate. Hope not to offend with my post, just one poor doc's experience.

[Melaniee]

I'm not offended, of course one problem is that a mother with a sleepy newborn who doesn't want to latch probably won't have any milk to give. I wonder if one pumps, how long it takes for milk to come in? I pumped a bit in the hospital, but that with Ds my milk still didn't come in for 4 (or was it 5) days.