Help with 2 day old newborn and jaundice

[nannybutterfly]

I need any help/advice from experienced moms! My 2 day old son is slightly jaundiced. His levels are 10 mg as of 6am this morning. The in house pediatrician wants to give him formula.... I said no for now, which was not taken well, but the pedi said the jaundice wasn't that concerning yet. They are going to take his levels again at noon and we will "reassess" the formula situation then. He is nursing about every 1-2 hours for about 10-20 minutes per side. He is having lots of wet and dirty diapers too. He was 10 lbs. 5 oz at birth and is now 9 lbs. 14 oz. What can I do to help him and prevent the formula. If he has to have formula is there any other way beside a bottle to give it to him? The dr. threatened that if I didn't give him formula, that he would have to go to the nursery to be under the lights. Can I refuse this too? I don't want them sending child services after me either...Any suggestions would be greatly appreciated.
Thanks!

[PatioGardener]

You can ask for a bili blanket that you can use to cover him on you WHILE you nurse him!

If they don't have that, then being with him while he is under the lights and nursing every 1-2 hours will help.

Also what may help is to pump or hand express after day time feeds to help your milk to come in faster.

Hang in there, Mama!

Some info that may help: Jaundice: http://www.nbci.ca/index.php?option=...tion&Itemid=17

http://www.nbci.ca/index.php?option=...tion&Itemid=17

http://www.nbci.ca/index.php?option=...tion&Itemid=17

[momto4plus4]

My son was jaundiced and my friend is a NICU nurse. My son's levels got up to 14 and they never had to do intervention. My friend said the more they poop the better they'll be as that clears the jaundice. They never pushed formula on us for the jaundice. My son did have to have some for his blood sugar levels but it was Very minimal. They told me there were 3 levels of jaundice: low, intermediate and high and that intervention wasn't needed if it stayed in the low or intermediate range even on the high-end of intermediate. 10 is not high. And, I agree with the other post-pumping may help bring your milk in quicker and at least maybe get some extra colostrum out. (((hugs)))

[Juvysen]

these might help: http://www.kellymom.com/babyconcerns...-jaundice.html

All three of my kids had some jaundice, but we never had any tests done to determine amounts. It cleared up by a week. Put baby in the sunlight, if you have a window, it also helps clear the jaundice. And maybe ask for YOUR OWN ped to evaluate the baby? Especially if you have a breastfeeding friendly ped...

[SallyN]

There is nothing magic about formula with regards to treating jaundice. The reason it works is because the treatment is to get fluids through the baby. If baby is nursing effectively than that's the ideal. If, and I mean IF, you do decide to supplement... ask for a lactation aid (ie: sns). But first, request an LC (ideally an IBCLC) to evaluate baby's latch and effective milk transfer (weigh before and after a 'good' feeding). IF there's a concern over effective nursing and supplementation is chosen, request a hospital grade pump and you pump and supplement with your own milk.

[rhiOrion]

Most babies are somewhat jaundiced around this time. We spent a lot of time sitting with L in semi-direct sunlight and indirect sunlight. I nursed nursed nursed to get my milk to come in. Pretty much as soon as my milk came in she started pooping more and the jaundice dissapeared.

You're not in the dangerous levels, or even close, I don't think. Though I had trouble finding a good resource on what levels were okay and what were bad.

If they keep really pushing formula, maybe you could come to a longer term agreement. If his levels don't get above ___ number, and your milk comes in by ___ day, they'll agree to lay off the formula talk, or something like that.

My milk didn't come in until Monday morning, and she was born on Thursday afternoon.

[SallyN]

I did a little more research 'cause while the levels calling for 'treatment' are vague, 10mg seemed low to my memory.
Going to some articles in Pediatrics, 10mg at >48hrs of age doesn't even warrant treating with phototherapy (bililights or sunlight even.) In other words, IMO this ped is being way off base by threatening formula. I'd definitely consult with your personal ped.

I'm sure you're not up for reading technical(ish) articles, but here's one I found: http://pediatrics.aappublications.or...e2=tf_ipsecsha
Sorry for the long link. That's the abstract from where you can download the full article. Page 4 specifies levels and treatment protocols broken down by age of baby.

"Phototherapy may be considered for the 49- to
72-hour-old jaundiced infant when the TSB level
is 15 mg/dL (260 pmol/L). Phototherapy is recommended
when the TSB level reaches 18 mg/dL
(310 pmol/L). If intensive phototherapy fails to
lower the TSB level when it reaches or is predicted
to reach 25 mg/dL (430 pmol/L), an exchange
transfusion is recommended. If the TSB level is
30 mg/dL (510 pmol/L) when the infant is first
seen, intensive phototherapy is recommended
while preparations are made for exchange transfusion.
If intensive phototherapy fails to lower the
TSB level, an exchange transfusion is recommended.
4. For the infant >72 hours old, phototherapy may be
considered if the TSB level reaches 17 mg/dL (290
pmol/L). Phototherapy needs to be implemented
at a TSB level of 20 mg/dL (340 pmol/L). If
intensive phototherapy fails to lower a TSB level
of 25 mg/dL (430 pmol/L), exchange transfusion
is recommended. If the TSB level is 30
mg/dL (510 pmol/L) when the infant is first seen,
intensive phototherapy is recommended while
preparations are made for an exchange transfusion."

[bubbamummy]

Here's a great website for determining what baby needs with regard to treatment.


http://bilitool.org/


My DD was 13.2 at 47hrs old and they freaked out the website concluded she was boarderline and really only needed phototherapy IF she had other risk factors (prematuraty etc) she didnt. Nevertheless, they pushed formula and I declined. I used a hospital grade pump to pump colostrum - you only need a VERY small amount, remember that a newborns tummy is super small. I finger fed her the colostrum with an SNS. Be forceful, if you dont want to give formula you dont have to. There are MANY other options.

[nannybutterfly]

Thank you so much for all your help! His noon levels were 10.5, so good news! He is still slightly yellow, but has been nursing so much today. He wants to nurse about every hour, so I let him even though the nurses are telling me I'm feeding him too much... I found a lactation consultant who told me no I do not need to give him formula. She got me a pump to use after I nurse, so that my milk will come in sooner. She said if we have to use formula we can do it by cup feeding. I'm so grateful that she found us! I told the pedi no formula, and he was fine with it. He wants to check his levels again in the morning, but hopefully they will be fine. Baby has had 4 poopy diapers and at least 5 wet diapers today, so he must be getting what he needs. Now if only I could get the nurses to stop trying to give baby a pacifier and take him to the nursery... we get to leave tomorrow morning if his levels are good. I'm so ready to go home. We would not have been here if I didn't have high blood pressure, but there's not much I can do about that. Thank you again for all your help.

[momto4plus4]

[QUOTE=nannybutterfly;15385827]He is still slightly yellow, but has been nursing so much today. we get to leave tomorrow morning if his levels are good. I'm so ready to go home. QUOTE]

So glad that things are going better and his 10.5 is great! Just a note, it can take a while for the yellow to really clear. My baby's highest number was 14 but he still had yellow eyes at day 7 and the jaundice coloring wasn't completely gone until about day 12. We did have a home nurse at day 8 and that helped as she checked the jaundice. The further down the body, the worse it is. If it's confined to the face it's not so bad but if it progresses to the chest then take him in.

Hope things go much better at home!

[SallyN]

that's wonderful news! (silly nurses!)

[Claire and Boys]

it's funny how doctors in America are over jaundice, I think. Both my kids had jaundice for about the first 2-3 weeks of life, and it was all down the body to the chest that I remember, they didn't even check levels, no mention of formula or lights. Once I got home I put them in a moses basket next to the window when they weren't nursing. They're both beautiful healthy boys and the jaundice didn't hurt them at all.

[bubbamummy]

Originally Posted by Claire and Boys

it's funny how doctors in America are over jaundice, I think. Both my kids had jaundice for about the first 2-3 weeks of life, and it was all down the body to the chest that I remember, they didn't even check levels, no mention of formula or lights. Once I got home I put them in a moses basket next to the window when they weren't nursing. They're both beautiful healthy boys and the jaundice didn't hurt them at all.

Im from England and had my son there. He had hideous jaundice - the midwife called him a 'Simpson' and no one mentioned lights, blood tests or anything!!

[ShwarmaQueen]

You've gotten great advice so I won't repeat, but I just want to offer support. Both my kids were significantly jaundiced, for longer than a week, but neither had to have forumula. True, dangerous jaundice is pretty rare, most is more appearance than anything else.

Next time the doc comes to push formula (geez, I mean, are the formula companies paying him or WHAT?) ask a hundred questions to get him to back off- so what is the point of formula if shes getting lots of breastmilk, how is formula better, what is the dangerous level (above 14 I've read) compared to where she is now? Chances are the more education that you show, the less pushy he'll be with the formula.

[sugarpop]

I just wanted to offer support and say I have been there. My daughter was jaundice and still at 10+ at 4 days old. They pushed formula and I caved. I went with a bottle it was a disappointment but today she is 7+months old and the formula is no longer a blip on my radar.

We did supplement for 2 or 3 days maybe 4 she got a total of 5 tiny formula bottles over that time. Her jaundice improved...

Now how to avoid a bottle and yes there are other ways, I have heard of spoon feeding and tubes...the tube can be placed on your finger or inside a nipple shield then against your breast so when the babe latches on and feeds they get some formula. A lactation consultant should be able to help with this...our had the stuff to do this, unfortunatley I met her after the formula was given.

ETA: Lights and blankets shouldn't be used until numbers are approaching 20! Otherwise it will dehyrate the babe and make the jaundice worse. That is per the hospital that I gave birth in and my midwife. 15 minutes outside in the sun exposed to the rays a day (not between 11 and 1, sun is too strong then)

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