AndyJoy Posted July 30, 2013 Share Posted July 30, 2013 So Lyla was admitted to the hospital yesterday with a bilirubin level of 18. 10 hours later it was 16.4 after frequent nursing and about 5-6 hours under photo therapy. Her next blood test will be at midnight and the pediatrician has mentioned that if her level doesn't drop "enough" I "may" be asked to pump and not nurse for 24 hours. I'm finding mixed information about this online and some of it leads me to think the Dr. is perhaps overly-cautious at this level or out of date. The onset was at 4 days, not after a week which from what info I can research by smartphone points to it NOT being the less-common "breast milk jaundice" which would lead us to delay breastfeeding while levels drop. I know you are not doctors but I could use your help with experiences/information so I'm not at a loss with the Dr. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 I realize this may not even be an issue if her levels have dropped "enough" but if you're willing to speculate with me I'd like to be armed ahead of time. Quote Link to comment Share on other sites More sharing options...
Whereneverever Posted July 30, 2013 Share Posted July 30, 2013 http://kellymom.com/health/baby-health/bfhelp-jaundice/ Quote Link to comment Share on other sites More sharing options...
twoxcell Posted July 30, 2013 Share Posted July 30, 2013 I think that is nonsense, but I'm not a doctor. ;) I hope your little one is better soon. Quote Link to comment Share on other sites More sharing options...
staceyobu Posted July 30, 2013 Share Posted July 30, 2013 http://www.askdrsears.com/topics/breastfeeding/special-situations/babies-jaundice I found this. He seems to give 20 as a cut off for when to take action. Quote Link to comment Share on other sites More sharing options...
*Lulu* Posted July 30, 2013 Share Posted July 30, 2013 I am kind of surprised they admitted her at 18; all three of mine were jaundiced and 20 was the number I heard each time we discussed hospitalization. My experience nursing through jaundice was that the numbers came down more slowly than some pediatricians are comfortable with. (Two of mine received extra sun therapy, the third spent a month in a biliblanket) My pediatrician that was very supportive of nursing was never freaked out even when the numbers got high, but the pediatrician that had very little experience with nursing mothers was almost alarmist. Saying all that to ask, in other ways has this pediatrician been supportive and knowledgable about breast feeding? Quote Link to comment Share on other sites More sharing options...
PrairieSong Posted July 30, 2013 Share Posted July 30, 2013 One of our sons had a bilirubin level of 19 and was not readmitted to the hospital. I kept nursing, though he was sleepy from the jaundice, and took him in for blood tests a couple of times. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 Sadly our normal pediatrician just retired but I didn't find out until right before I gave birth. So this is the on-call pediatrician who I don't know much about. She has been practicing for 40 years or so and I have gotten an inkling that some of the nurses find her old-fashioned or overly-cautious. Quote Link to comment Share on other sites More sharing options...
Ellie Posted July 30, 2013 Share Posted July 30, 2013 So Lyla was admitted to the hospital yesterday with a bilirubin level of 18. 10 hours later it was 16.4 after frequent nursing and about 5-6 hours under photo therapy. Her next blood test will be at midnight and the pediatrician has mentioned that if her level doesn't drop "enough" I "may" be asked to pump and not nurse for 24 hours. I'm finding mixed information about this online and some of it leads me to think the Dr. is perhaps overly-cautious at this level or out of date. The onset was at 4 days, not after a week which from what info I can research by smartphone points to it NOT being the less-common "breast milk jaundice" which would lead us to delay breastfeeding while levels drop. I know you are not doctors but I could use your help with experiences/information so I'm not at a loss with the Dr. Call La Leche League. When you say "frequent nursing," how do you define that? Every hour and a half to three hours is optimal, with no water or pacifiers or anything except nursing. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 DH is going to call the practice of our former ped and see if one of the remaining doctors can take her on. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 She is nursing every 1.5 to 2.5 hours but also using a paci part of the time. She's had 20+ wet or soiled diapers in 24 hours. Quote Link to comment Share on other sites More sharing options...
GinaPagnato Posted July 30, 2013 Share Posted July 30, 2013 I had the same thing happen with one of my dc, and the admitting number was always 20. Perhaps things have changed over the last 15 years or so. At that point I was encouraged to continue nursing, and when I wasn't present the nursing staff gave my son the milk I was pumping around the clock. Like I said, perhaps things have changed, so my experience may not be useful. I know how stressful it is, though, so you have my hugs and prayers that your little one will soon be home in her crib, where she belongs. :grouphug: Quote Link to comment Share on other sites More sharing options...
mom2myboys Posted July 30, 2013 Share Posted July 30, 2013 Is there a lactation consultant there at the hospital that could see you and evaluate milk transfer? Or a call to a LLL Leader would be helpful as well. Thinking of you. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 Some feedings have only been 1 hour apart Quote Link to comment Share on other sites More sharing options...
ktgrok Posted July 30, 2013 Share Posted July 30, 2013 breastmilk is a laxative, and will be better at getting the poop out (which carries the bilirubin) than formula. Stick to your guns. Quote Link to comment Share on other sites More sharing options...
Ellie Posted July 30, 2013 Share Posted July 30, 2013 She is nursing every 1.5 to 2.5 hours but also using a paci part of the time. She's had 20+ wet or soiled diapers in 24 hours. That's good, other than using the paci. When she uses the paci instead of nursing, she's affecting your milk production. Under these circumstances, I'd encourage you to throw that thing away. The more bre@stmilk that goes through her, the sooner the jaundice will go away. Quote Link to comment Share on other sites More sharing options...
mom2myboys Posted July 30, 2013 Share Posted July 30, 2013 You can try breast compressions while feeding her to keep her interested and taking in more milk. More milk means more poop which usually brings down the bili levels. Is she sleepy at the breast? (common with higher bilirubin levels) ETA: Here is a link to some videos. I esp. like the really good drinking and the good drinking ones. It can help you evaluate the effectiveness of her nursing. She can nurse very often, but if she is not drinking well, it won't be as helpful. I believe one or both of these videos demonstrates the compressions too. http://breastfeedinginc.ca/content.php?pagename=videos Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 I'm torn on the paci because it is sometimes the only way to keep her from freaking out in the light bed. I'm not using it to delay feedings--she is very clear when the paci won't cut it. It's not in her mouth all the time, just during transitions until it falls out. Quote Link to comment Share on other sites More sharing options...
*Lulu* Posted July 30, 2013 Share Posted July 30, 2013 Can they do a bili blanket instead? ( That way you could hold her and she might not freak out so much. ) Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 I have TONS of milk as I did with my son and she seems to be getting a lot once she can get through the initial sputtering flood. She is sleepy so I've been working hard to keep her sucking. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 30, 2013 Author Share Posted July 30, 2013 Our hospital I'd pretty rural/basic/old so I doubt they have biliblankets. They do have a pad that covers her back while nursing. Quote Link to comment Share on other sites More sharing options...
Allearia Posted July 30, 2013 Share Posted July 30, 2013 With my second his bilirubin went up to I think even slightly above 18, we were right on the verge of having to do the light therapy. I was exclusively breast feeding, and as the ped is in Berkeley they were very supportive and just said keep nursing as much as possible. The next day or the day after it had come down, sorry I can't remember the numbers, and I just kept nursing as much as possible. I didn't read the other posts so hopefully someone has some more recent info but from my experience it was important to just keep nursing and checking to make sure the jaundice is going down. Quote Link to comment Share on other sites More sharing options...
Heather in OK Posted July 30, 2013 Share Posted July 30, 2013 Good advice here! When will they release her so you can get her home to nurse and do sunbaths?? :grouphug: Hang in there Mama!! Quote Link to comment Share on other sites More sharing options...
LibraryLover Posted July 30, 2013 Share Posted July 30, 2013 :grouphug: Quote Link to comment Share on other sites More sharing options...
Harriet Vane Posted July 31, 2013 Share Posted July 31, 2013 Stand your ground. :grouphug: Quote Link to comment Share on other sites More sharing options...
Dancer_Mom Posted July 31, 2013 Share Posted July 31, 2013 There is NO reason to switch. Your baby is having plenty of wet diapers so your milk supply is not the issue... switching to bottles wouldn't change a thing. When my baby was in the hospital he did have the bili blanket underneath him at the same time the light was on. Every time I nursed we would swing the light around on him so that he had the light at all times. Honestly that level is not high enough to cause brain damage so I think your doctor needs to be more patient as you are not putting your baby at risk. Stand your ground - GOOD LUCK. Quote Link to comment Share on other sites More sharing options...
Guest Posted July 31, 2013 Share Posted July 31, 2013 Time to fire your doctor. The same thing happened to me with dd1 and CPS was called when I tried to check her out of the hospital AMA. dd2 and ds1 had much higher bilirubin levels than their older sister, but the new ped told me to nurse them as much as I could and take them for walks in the sunlight, but if I just couldn't get out of the house, I could take off all their clothes except the diaper and put the baby by a window for fifteen minutes every day. dd1 is 25 now, dd2 is 24, and ds1 is 21. None of them have any brain damage unless you count the same personality quirks everyone in my family has. I can't believe doctors are still giving out this terrible advice and scaring new mothers this way! I apologize if I sound as angry as I feel. I'm not angry at you. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 31, 2013 Author Share Posted July 31, 2013 Thanks for all the help! The nurse just told me they are hoping for a 10 or less at midnight. If so, she will be out of the light until 8 am then rechecked. I will stand my ground if necessary. 16.4 ( or lower, which I'm sure it is) isn't dangerous. If it takes a bit longer, so be it. I don't want to interfere with breastfeeding. If necessary I'll call the hospital lactation consultant from whom I've had good help before. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 31, 2013 Author Share Posted July 31, 2013 This pediatrician is probably in her late 60s or early 70s I would guess, so maybe out of touch. DH was able to make an appointment for Monday with the new guy in town who joined the office of our now-retired former pediatrician. We've been happy with that practice before and they were very supportive and knowledgeable about breastfeeding so hopefully the new guy is in line with that. Quote Link to comment Share on other sites More sharing options...
kubiac Posted July 31, 2013 Share Posted July 31, 2013 I generally tend to trust the medical establishment (which I realize is not necessarily a common position around here or anywhere these days), but I'll swear, their knee-jerk alarmist reactions to newborn jaundice just speak to me of an extreme fear or misunderstanding of breastfeeding in specific and natural parenting in general. They need to chill out and stop terrifying mothers and just leave them alone to nurse their darn babies! Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 31, 2013 Author Share Posted July 31, 2013 Yeah, my personality is to follow the rules and trust the "experts" but this just seemed off. Hoping for a 10! Quote Link to comment Share on other sites More sharing options...
Ellie Posted July 31, 2013 Share Posted July 31, 2013 Yeah, my personality is to follow the rules and trust the "experts" but this just seemed off. Hoping for a 10! I trust the experts only so far. Medical doctors aren't necessarily the experts when it comes to bre@stfeeding issues, and that's what this really is. Jaundice often makes the babies sleepy, BTW. You keep nursing that baby, regardless of what the numbers are. And find a La Leche League leader in your area, and call her. Quote Link to comment Share on other sites More sharing options...
YaelAldrich Posted July 31, 2013 Share Posted July 31, 2013 My youngest was up to 26 at his worst point (ABO incompatibility). Never stopped nursing, only used a paci to get him to sleep if the nursing didn't drug him. :) Make sure they are using the newest lights they have (they lose strength after a while) and as close as they can safely put it and if they have the blil blanket to put it under him while he is under the lights. I came into the hospital raring for a fight, but they never said boo (unlike when I lived in Boston). Just told me to nurse as much as possible and keep him under (or in) the lights as much as possible. It took almost a week but then we got him down to 15 and then took him home with a biliblanket for two more weeks. Quote Link to comment Share on other sites More sharing options...
happypamama Posted July 31, 2013 Share Posted July 31, 2013 I agree with PPs -- just keep nursing, and stand your ground. Three of my four have had mild jaundice, although their levels were never tested. It certainly sounds like you have plenty of milk, and like she's getting lots of it, if she's making so many wet diapers. The only thing I would consider doing is to call LLL or a board-certified lactation consultant (not necessarily a hospital "LC" -- they don't always have significant training, but an IBCLC will have plenty) or even a WIC peer breastfeeding counselor if you happen to be a WIC participant, in order to have her evaluated for milk transfer issues, such as tongue or lip tie. It doesn't sound like those are concerns, but it might be worth a call. Quote Link to comment Share on other sites More sharing options...
kahlanne Posted July 31, 2013 Share Posted July 31, 2013 All but one of my 6 had jaundice and breastfed. With my first, my pediatrician told me I must stop breastfeeding. He even gave me samples of milk to use. I never stopped breastfeeding or opened the can of milk. When we went back for exam, he praised the new milk as the cure. I fired him immediately after informing him otherwise. She wasn't bad enough to be on light therapy. My last 4 all needed light therapy but at home. My pediatrician was pro breastfeeding and was willing to keep monitoring to allow time for it to flush their system. He said I needed to wake ever few hours to make sure baby was eating more often. Usually he suggests not waking a sleeping baby at night but the more milk in, the more bilirubin out. With #5, his bilirubin levels were continuing to rise and he was loosing too much weight. Because of the weightloss, from not nursing well enough, he had to be bottle fed. I was devastated. While in the hospital, the on call ped scared me into using a bottle because of his levels and I know this caused nipple confusion. When my ped came back from vacation, he said he would have never suggested to do anything but bf especially with hs levels, 18. He tried to help me with continuing bf even ordering a special tube thing to hook up from bottle to breast. Didn't work. I wish a thousand times over I would have stood my ground those first few days. I know nipple confusion was an issue. Btw, all mine took pacifiers except this child. So I would suggest that you stand your ground if youre sure baby is getting plenty of milk. It was evident mine was not. Prayers and good vibes sent your way. Quote Link to comment Share on other sites More sharing options...
Word Nerd Posted July 31, 2013 Share Posted July 31, 2013 My younger DD was up to 24, but her levels dropped quicly under the lights. She was in NICU for about 24 hours then at home with a bilibed for 2-3 more. I did supplement with formula at that point, as I had trouble with my milk supply and everyone--her pediatrician, two lactation consultants, and I--agreed it was necessary, as she had also lost too much weight. They still never recommended that I stop nursing entirely, even for a day. Quote Link to comment Share on other sites More sharing options...
rjand6more Posted July 31, 2013 Share Posted July 31, 2013 With last ds(4 mos) I was asked to stop nursing for 24 hours because of "breastmilk jaundice". I think he was about 2 weeks old. I so did not want to, but the pressure was too much. His ped said she would put him in the hospital if I didn't. I pumped for 24 hours( and occasionally let him nurse after I pumped, just to calm him). I collected 14 oz in 24 hours. I was very sore and did not torture with pumping or it could have been more. He was NOT having an issue with amount. After the day, his numbers went down a bit(may have anyway...) It was enough for his ped to back off. I was just so sick of the daily heel sticks. Poor baby. Make sure you hold baby with feet dangling and warm that heel up!! The first few times, they stuck him while in his carseat. It took forever! My sil is a phlebotomist(sp?). She said to never let that happen again. He bled so much better with me holding him and his feet dangling. Why did I not think of that? I blame lack of sleep. Prayers for a 10. Quote Link to comment Share on other sites More sharing options...
Tiffnkids Posted July 31, 2013 Share Posted July 31, 2013 I have TONS of milk as I did with my son and she seems to be getting a lot once she can get through the initial sputtering flood. She is sleepy so I've been working hard to keep her sucking. Not sure that this will help with the jaundice . . . But look into "overactive letdown". If you are having a sputtering flood of milk. The quick advice is to put baby to breast until letdown, then remove baby from breast until the milk is done squirting/gushing (note: baby will not be thrilled with this at first but will get used to it after multiple feedings, I just soaked up the extra foremilk with a folded cloth diaper), put baby back on breast . Also, using one breast per feeding can help baby get the good hindmilk if you have an oversupply. Too much of the flood of foremilk tends to make babies gassy and fussy. They also fill up quickly, but then are hungry again very soon. Please disregard the above if it is not helpful or does not apply to your situation. My fourth baby was jaundiced (don't know the numbers). We were able to rent a biliblanket from a medical supply company and keep baby home (and we live in a very rural area). Hopefully you will be able to do something like that when your little sweetie's bili comes down enough. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 31, 2013 Author Share Posted July 31, 2013 Not sure that this will help with the jaundice . . . But look into "overactive letdown". If you are having a sputtering flood of milk. The quick advice is to put baby to breast until letdown, then remove baby from breast until the milk is done squirting/gushing (note: baby will not be thrilled with this at first but will get used to it after multiple feedings, I just soaked up the extra foremilk with a folded cloth diaper), put baby back on breast . Also, using one breast per feeding can help baby get the good hindmilk if you have an oversupply. Too much of the flood of foremilk tends to make babies gassy and fussy. They also fill up quickly, but then are hungry again very soon. Please disregard the above if it is not helpful or does not apply to your situation. My fourth baby was jaundiced (don't know the numbers). We were able to rent a biliblanket from a medical supply company and keep baby home (and we live in a very rural area). Hopefully you will be able to do something like that when your little sweetie's bili comes down enough. Yes I learned about this with Ds after 4 months of green frothy diapers and hourly feedings because he wasn't getting hind milk. I finally googled the right combo and found this info. I'm just nursing on one side at a time already. I'm not spraying like I did with ds fortunately. I became the oversupply preacher at every subsequent LL meeting that had a new mom so she could avoid our issue! Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 31, 2013 Author Share Posted July 31, 2013 The light bed has a lighted panel under her too so that is good. I am going to request an arm draw instead of the heel. She had one of each yesterday and the arm was so much quicker and less traumatic. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted July 31, 2013 Author Share Posted July 31, 2013 Her level was 11.5 so she stayed in the bed and will be retested in 30 min. After Googling for pics I see that we have been using a biliblanket while she nurses. I envisioned something more blanket-like than the pad-like thing it is. Quote Link to comment Share on other sites More sharing options...
Dory Posted July 31, 2013 Share Posted July 31, 2013 20 was the cut off for my kids and for my little brothers 21 years ago. Under that we just did lots of sunlight and nursing every hour. Even when my little girly was past the cut off and we were in the hospital my doctor was encouraging me to wake her up every hour and nurse. I had to strip her down and pat her to get her to wake up enough to nurse. Quote Link to comment Share on other sites More sharing options...
Truscifi Posted July 31, 2013 Share Posted July 31, 2013 Ds9 was well over 20 and stayed in the light bed for almost a week, but it was never suggested that he have formula. Our hospital didn't have biliblankets (I don't even know what that is, lol) so ds had to stay under the light even while eating at first. The nurses brought me a pump so I could pump and feed him that way, switching between one pump and feed under the lights and one nursing session so he wouldn't get too used to the bottle and not want the breast. They said the breastmilk would bring down his levels faster than formula. Quote Link to comment Share on other sites More sharing options...
Tammyla Posted July 31, 2013 Share Posted July 31, 2013 :grouphug: I hope Lyla is doing better today. Quote Link to comment Share on other sites More sharing options...
AndyJoy Posted August 1, 2013 Author Share Posted August 1, 2013 Thank you so much everyone! At the next draw her level was 9.7 and only rose to 10.1 after 6 hours without the lights so she was sent home. I didn't have to stand up to the Dr but it was great to feel prepared and not intimidated. I'm so glad to have you ladies for a sounding board and support. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted August 1, 2013 Share Posted August 1, 2013 Woo hoo, Andy Joy and Lyla! Quote Link to comment Share on other sites More sharing options...
Chelle in MO Posted August 1, 2013 Share Posted August 1, 2013 Great news! Quote Link to comment Share on other sites More sharing options...
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