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How NOT to deal with jaundice

post #1 of 8
Thread Starter 

We just went through jaundice treatment a few weeks ago and I thought I'd share our story in case anyone else searches for help down the road!  To sum up what we learned... the treatment can mess up your breastfeeding schedule, so make sure to breastfeed for long sessions, that's 20 minutes on one breast at a feeding.  Here's the story:

 

At day 5 our preemie (born at 36 weeks) went back to the hospital for jaundice treatment... he had a bilirubin level of 21.5.  We started phototherapy, i.e. bililights.  The doctor stressed the importance of breastfeeding to flush out the bilirubin, but the bilirubin and the lights make babies sleepy and ds fussed more because he didn't want to be laying out of my arms under the lights.  Result: I fed ds more often, either when he fussed or when I woke him at least every 2 hours. A few hours later ds started having green poops (before returning to the hospital he had gotten all the meconium out and was having normal yellow breastfed poops).  The hospital doctor said that just meant that being in the hospital had altered our breastfeeding schedule a bit, no worries.  We go home.

 

The next day, the bililevels are back up and he has not gained any weight in 2 days.  I talk to the Lactation Consultant at my pediatrician's office.  She says the green poops mean ds is only getting foremilk and not hindmilk.  When we had started feeding more often in the hospital, ds was sleepy so he fed more often but for less time at each feeding.  She said when newborns feed, it takes 5-8 minutes to get the foremilk out of one breast and the milk they get after that from that breast is the hindmilk.  This is important because the HINDMILK IS WHAT FLUSHES THE BILIRUBIN OUT and also what makes babies grow and gain weight.  The foremilk is more watery and only satisfies thirst.  So she told me to feed often (at least every 2-3 hours) and do everything I could to keep ds awake and sucking for 20 minutes on one breast at each feeding.  This got us back to yellow poop, gaining weight, and lower bili levels within a day or two.  Thank goodness for the Lactation Consultant... otherwise we might have been looking at weight loss or failure to thrive and more serious jaundice treatments. 

 

It would have been nice if the doctors/nurses at the hospital had explained this to me instead of messing up our breastfeeding schedule.  And to top it off, ds got a staph infection at the hospital... thankfully it wasn't mrsa.

 

Cross-posted in the Life with a Babe forum...

post #2 of 8

Thanks :) That's great info.

post #3 of 8
I'm surprised you had to have him back at the hospital.

When my son was born, nearly 17 years ago, now, he also had jaundice. We were told when released from the hospital that there was nothing we had to do for it, but we could take him for a totally free visit to the pediatricians in 2 days.

I insisted that we did, and we were told that he wouldn't have been able to be woken in another 48 hours time (if bilirubin numbers were given, they didn't stick with me). He was prescribed light therapy at home!

The visiting nurse who showed us how it all worked also told me to wake him every 2 hours from when he started nursing, let him nurse as long as he wanted on the first side, then offer the second. That was at 10 o'clock at night. I followed her advise, a different visiting nurse came to take another blood sample the next morning, around 11.

When the pediatrician called at 5pm with the results, he said we could quit light therapy, and my son would be fine. In fact, he had never seen a child turn around so fast from jaundice! I told him what the first visiting nurse had me do, and he dismissed it, giving credit to the light therapy. Doctors!

Edited for typo.

What our visiting nurse told me supports what you were told. Hindmilk is important!
Edited by pek64 - 9/3/12 at 12:49pm
post #4 of 8
Thread Starter 

pek64, thanks for sharing your story!  The pediatrician said their standard procedure is to send anyone with a level over 20 to the hospital for the triple light therapy... under 20, they do a bili-blanket at home.  After we left the hospital, we still used a bili-blanket for 3 days.

 

Oh, I forgot to add that our hospital pediatrician was surprised that ds's bili level went down so quickly in the hospital, from 21.5 down to around to 13.5 in less than 24 hours.  She said this was probably due as much or more to my milk coming in, ds getting the meconium out the day before (which is sticky and prevents the bilirubin/yellow poop from getting out), and having yellow poops as it was due to the bili-light treatment.  But alas, then the green poops came and the magic hindmilk wasn't able to continue doing its job.

post #5 of 8
Quote:
Originally Posted by pek64 View Post

I'm surprised you had to have him back at the hospital.
When my son was born, nearly 17 years ago, now, he also had jaundice. We were told when released from the hospital that there was nothing we had to do for it, but we could take him for a totally free visit to the pediatricians in 2 days.
I insisted that we did, and we were told that he wouldn't have been able to be woken in another 48 hours time (if bilirubin numbers were given, they didn't stick with me). He was prescribed light therapy at home!
The visiting nurse who showed us how it all worked also told me to waked him every 2 hours from when he started nursing, let him nurse as long as he wanted on the first side, then offer the second. That was at 10 o'clock at night. I followed her advise, a different visiting nurse came to take another blood sample the next morning, around 11.
When the pediatrician called at 5pm with the results, he said we could quit light therapy, and my son would be fine. In fact, he had never seen a child turn around so fast from jaundice! I told him what the first visiting nurse had me do, and he dismissed it, giving credit to the light therapy. Doctors!
What our visiting nurse told me supports what you were told. Hindmilk is important!

 At levels over 20 they are hospitalized because it can cause organ and brain damage a I think 24.

post #6 of 8
I don't know what his levels were, or what the procedures were in those days. Perhaps similar.

Either way, the point is longer nursing sessions played a part in recovery. And that needs to be communicated to all breastfeeding moms of jaundiced babies.
post #7 of 8
Thread Starter 
Quote:
Originally Posted by pek64 View Post

I don't know what his levels were, or what the procedures were in those days. Perhaps similar.
Either way, the point is longer nursing sessions played a part in recovery. And that needs to be communicated to all breastfeeding moms of jaundiced babies.


Yes, exactly!

 

Just remembered one more thing... the Lactation Consultant also suggested that I could try pumping some of the foremilk out before latching ds on so he wouldn't have to wait for let-down since he was sleepy  and could get to the hindmilk quicker.   I'm terrible with pumps and hand-expressing, but fortunately my 4yo dd remembered how to breastfeed and was eager to try, so she would breastfeed for a minute or so before I put ds to the same breast.  

post #8 of 8
Doctors know nothing about breastfeeding!
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