ABO Blood Incompatibility

[FarmgrrlRN]

Can anyone tell me how common this? Does it occur in all Moms that are O blood type with babies that are A or B blood type?

The reason I ask is that one of my bestfriends gave birth on Mon PM and baby has developed jaundice ('discovered' @ approx. 32 hrs old;Weds AM), with a bili level of 16.9, and is now receiving phototherapy. I guess you could say I'm looking for the scoop on this and how serious it is. I have read my nsg textbooks and done research online, my friend was told that it would be 'really serious' when his bili level reaches 20. (I'm guessing at the point they would consider an exchange transfusion?)

Also, she is receiving conflicting information, pediatrician vs. nursery RN. Baby has not really taken to breastfeeding and they had given him 15cc of Enfamil with finger feeding to help him learn how to position his tongue on Tues PM (he did nurse early Tues AM, but then he refused). Then during the day Weds they did start giving him bottles and she is still trying to pump q3h but is getting very little colostrum. Basicially, pediatrician is telling her baby is fine, that she shouldn't be giving him bottles, the baby is not dehydrated, and she should continue to try to strictly nurse him and forget the bottle feedings. The nursery RN has told her he is dehydrated, he has crystals in his urine, mucous membranes are tacky, and that he needs to eat. I would think that the RN is on the right track with this as today is now Thurs and he still doesn't 'get it' with the breastfeeding. To this point when she pumps, only the nipple shields (don't know if thats the right word) get wet with colostrum and nothing gets in the bottle, so she has been wiping what she can with her finger and giving it to baby that way.

Any thoughts would be appreciated!

[KRVRN, BSN, RN]

Is he full term? How big?

[FarmgrrlRN]

Is he full term? How big?

7lbs 6oz, 37.5 weeks gestation

[christinemj]

Is a lactation consultant involved??? Some women have a difficult time with pumping, but have adequate amounts when the baby nurses.

I agree with the pediatrician...especially if baby was fed yesterday by bottle. Spending the next day or two working on exclusive nursing would be beneficial for both mom and baby. BTW, doesn't the formula feed need to be ordered?? The ped. order trumps the nurse's suggestion, so why are they continuing to bottle fed formula?? The baby won't "get it" about breastfeeding if he isn't given the chance to nurse and a bottle is used every time. Good luck!!! Maybe shift change will produce better results. (SAD!!)

Here's the definitive source on treatment of hyperbilirubinemia http://www.aap.org/policy/hyperb.htm

[FarmgrrlRN]

Yes, I believe that she saw the LC on Tues and today (not sure about Weds). She is having trouble even attempting at getting him to latch on...when she tries he turns his head away and cries.

As far as the formula, I don't believe that it has to be ordered...she told me the nurses brought the formula into the room as they were attempting the finger feedings.

Wouldn't the baby's exposure under the bili lights increase his fluid loss?

[SmilingBluEyes]

YES, babies on bili therapy must have accurate I/O's and daily weights taken as dehydration is a very possible complication.

[fergus51]

Severely jaundiced babies are often terrible nursers. I have seen them do well after it's under control, but I've never seen a baby needing intensive photo just jump on the breast and go. Also, why nipple shields with the pump? As far as dehydration, isn't the baby getting fluids through an IV?

[FarmgrrlRN]

Severely jaundiced babies are often terrible nursers. I have seen them do well after it's under control, but I've never seen a baby needing intensive photo just jump on the breast and go. Also, why nipple shields with the pump? As far as dehydration, isn't the baby getting fluids through an IV?

fergus,

He is not on an IV...it seems dehydration has become an issue just today from what I gather...I was there on day 1 (Tuesday) and the PP nurse said he was not dehydrated, I'm not sure what the assessment was for day 2...but today is day 3 and the nurse in the nursery was concerned that he is dehydrated.

I don't think nipple shields was the correct term...I guess its the flange that is attached to the bottle that provides the suction...I don't know what the word is for that piece of plastic!

[fergus51]

Ok, I get what you were saying. We usually use IV fluids where I work on babies who are under photo and want to breastfeed because of the anti-nipple theories and because it's just hard to get some of these babies to eat well and stay under the lights at the same time:) Dehydrated, jaundiced babies have to be the worst feeders out there!

I have seen problems with post-partum nurses assessing jaundice/dehydration before and it's led me to be more welcoming of IVs than I was when I was a pp nurse. If a baby is jaundiced enough to require intensive photo, they are at risk for dehydration.

[mitchsmom]

speaking of shields, has she tried using a shield and seeing if the baby would latch with it (assuming everything else has been tried?)... she should keep pumping even if it's only drops, it's the stimulation that's important right now... her milk will probably come in any minute now... she should work up a plan with the LC and stay in contact until things are going smoothly...

[FarmgrrlRN]

I spoke with her last night and she is still pumping q3h. She was discharged last night but the hospital arranged to let her stay in one of the rooms on the Women's Unit so she and her husband can still stay with the baby at the hospital.

Everyone, thanks for you input on the BF issue...any thoughts on the ABO incompatibility???

[SmilingBluEyes]

In rare cases, transfusion therapy is needed if hemolysis of newborn blood cells is severe. If the baby is discharged home w/o evidence of tehis, it is likely the baby will do fine. I am sure the baby will be closely followed by his ped after d/c, as in some cases, bili's spike again and re-admission may be necessary for treatment.