A little help please...

  1. Hello Everyone!

    I'm not a nurse yet...not even an offical nursing student since I'm just finishing up my prerequisites...so please forgive any ignorance I may display in this message as far as terminology, phrasing, spelling etc...

    A friend of mine had her baby 2 weeks ago...she had a perfect pregnancy and an easy deliver...especially considering this was her first pregnancy...so everything's wonderful right?...well here's the question...

    The baby is now jaundice...this, I understand is usual in babies...but now she has to bring him back to the emergency room because his levels were 15.7 on the bilirubin test that was taken yesterday. So, what does this mean? Any information you could provide would be great! Thanks so much!

    ~Bean
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  2. 10 Comments

  3. by   Mkue
    hi bean.. i don't feel qualified to give you an answer, although i'm pretty sure i can come pretty close... calling obnurseheather !!
  4. by   Hooligan
    Oh...I forgot to mention, he has lost weight over the last two weeks also. He left the hospital at 8 lbs. but now weighs 7.1 lbs. I know babies lose weight at first but not 2 weeks into the deal...I'm just a little concerned...I thought at first the scales just could have been calibrated differently but when she got the call today to bring him into the hospital I got a little concerned. Thanks for the help!
  5. by   Hooligan
    Ahh...I've done a little reading and I feel a little better now, thankyou!
  6. by   flowerchild
    I'm glad your feeling better. Why didn't they set up home bili therepy when the s/s first started????? Maybe you don't have that service in your area? I used to do that when I did HHC. Worked out well for parents and the babies.
  7. by   nell
    bean 76:

    You're going to be a great nurse! You just got in there an looked up the info you needed. I suppose that since you are going to be a nurse, your friend is looking to you for info and support...

    Hyperbilirubinemia has several causes, but is usually just treated with hydration and special lights that break down the bilirubin so that it can be excreted from the babe's body via stool and urine. 15.7 on a 2 week old isn't bad (nowhere near needing exchange transfusion) but that along with weight loss sure needs to be looked at. At the risk of "stepping in it" I have to guess: breast-fed only baby?

    If you need any more info, just ask.
    Last edit by nell on Aug 14, '02
  8. by   bagladyrn
    Is your friend"s baby on bililights now? This is pretty much a "routine" problem (though not for the parents, of course!), unless there are other factors such as blood type incompatibilities, which would have showed up much sooner.
    In the mean time, encourage your friend to feed, feed, feed that baby - stuff him like a little piggie, since bilirubin is excreted mainly in the stool, the more he poops, the better.
  9. by   OBNURSEHEATHER
    Ahhh... it appears I am too late for this one. You've already gotten all the good answers!

    But I must know (along with nell): was he a breastfeeder?

    Heather
  10. by   Hooligan
    Hi Everyone!

    Thanks for all the input! And yes...as you all guessed, he's breast-fed. They were taking him to the hospital to be treated with the lights today, so hopefully these treatments will be all he'll need. I read that there were 2 possible different causes for this when related to breast-feeding...I'm still not sure which one it is in this case. From what Mom has said, it sounds like it could possibly be a combo of both. Mom has had difficulty with getting him to eat regularly so he'll sleep for 4-6 hours at a crack (of course not at night..haha) and skip feedings. Mom has attempted to wake and feed him, but he just won't feed...is this common? Anyway, as bagladyrn said...increased feeding would help the situation which is one of the reasons I read about today. On the other hand, her doctor seems to think that it is likely (more unlikely according to what I read?) the case where the baby can't metabolize and break down her breast milk. Also she had not blood type incompatibilities...

    Oh...also, one of the articles I read said not to discontinue breastfeeding and switching to formula temporarily because that would only provide a temporary fix and one breastfeeding resumed the levels would go up again. What are your opinions about this?

    So there's the situation in a nutshell!

    Oh...and Nell, Thanks for the compliment! I hope you're right! It's kind of funny though...I'm not even officially in nursing school and people are coming to me for advice and suggestion! I just keep telling them to come back and see me in 3 years 'cause I don't know Jack yet!

    Anyway, thank you again to all! I greatly appreciate your responses!


    ~Bean
  11. by   nell
    My personal opinion is to breast-feed and then pc (feed pumped breastmilk or formula after breastfeeding). With the weight loss and the relatively low bili level, dehydration due to inadequate intake is the most likely cause. Hopefully, they are weighing the babe before and after breastfeeding to find out how much the babe is getting. Also, working with a Lactation specialist to get the milk supply up and/or the baby nursing better.

    Usually in true breastmilk jaundice (which is very rare), the baby doesn't lose weight and the bili level is higher.

    At the risk of having to duck from incoming missiles, I will expound on my theory about current breast-feeding practices:

    People used to live in groups. One mom did not have the sole responsibility of feeding her babe (or if she was isolated, it would be more likely to die). In wealthy households there were servants or even wetnurses who would feed the babe when he continued to fuss after mom fed him or is mom's nipples were flat, sore too big etc.. In poorer households there were friends, sisters, aunts etc. that were available to nurse a hungry baby. Babies were FED.

    Today, people act as if formula is poison. I've had parents that thought the baby should starve all night when mom was discharged or wanted to sleep, rather than feed formula.

    I believe the increases we are seeing in Autism, learning disabilities and ADHD can in some cases be blamed on starving babies in the first few weeks of life.

    My own child has learning disabilities consistent with the effects of hypoglycemia. He weighed more than 10 lbs at birth (definitely LGA) and I breast fed exclusively (had a sister-in-law that was a Nipple-Nazi errr, I mean a La Leche League honcho and I was young and stupid...) No chemstrips were done and I didn't do babies in those days so I didn't know they should have been done. A few bottles of formula would have made all the difference until my milk supply was adequate.

    Okay, who wants the soapbox next?
  12. by   BBnurse34
    Our liver breaks down our old dead red blood cells. Sometimes a baby's liver is slow to get going on this, or has rh or ABO incompatability that worsens with breastfeeding. In the hospital, while under billi lights maybe mom with PC with formula to get the baby stooling out the billiruben.

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