Flushing out Jaundice - Do you need formula?

[earplugs]

Another post got me thinking..
DS spent several weeks in hosp with various complications being tube fed. He also developed severe jaundice that required the UV bed thingy. The Paediatrician instructed that he receive X amount of milk every 2 hours to 'flush it out' but at the time (day 3) I wasn't making the volume so this had to be formula.

My question (finally!) is, if a baby develops jaundice in the very early days before the milk has come in, is formula the only option?

(obviously this siutation was complicated by tube feeding when you know the exact volume the baby is getting but even if feeding directly from breast, there wouldn't be sufficient milk in the very early days?)

[phdlife]

no, dd needed a uv box too on day 3 and the head of neonatology said bfing was the best thing for her, though clearly my milk wouldn't have been in yet.

sorry to hear your baby had troubles, hope he's better now.

[pseudoname]

earplugs, colostrum works like a laxative to flush out meconium. If a baby does not start to pass meconioum in the first 24hrs, it starts to be reabsorbed by the gut which is sometimes referred to as 'not enough milk' jaundice.

so if a baby has not latched on successfully in the first few hrs, hand expressing colostrum and spoon or syringe feeding colostrum is an excellent way of getting the meconium out before it becomes a problem.

i know where you are coming from from 1st hand experience.

[tiktok]

Routine supplementation with formula for neonatal jaundice is not recommended under NICE guidelines, earplugs. You can check this for yourself.

But your baby had 'severe' jaundice so maybe he needed more volume than you could produce on day 3. Ideally donor breastmilk would have been available for you.

[sheeplikessleep]

agree with phdlife - my ds had jaundice and i was told breastmilk was best thing for him. he didn't go on the bed until day 5, so luckily i was able to express by then (although needed 70ml at a time to be tube fed, which was a lot for that time!).

[veryindecisive]

My DT1 developed jaundice on day 2. I bf him and gave him top ups of expressed breast milk. A few midwives said I should give him formula to flush it out, but my own community midwife said bf was the way to go, especially as he was 3 weeks early. (But I guess all cases of jaudice are different...)

Apparently all bf babies have a degree of jaundice, but usually it is an additional problem that increases the jaundice to a level needing treatment... (Ie my son had a big bruise on his head from ventouse).

[earplugs]

Thanks phdlife, this was a couple of years ago now so all well now but researching for next time round (hopefully!).

I remember them saying that breast milk was the best but seemed to be more concerned with the volume than worrying about formula issues. And i guess I felt that this problem was more important to resolve than my own personal desire for exclusive bf.

I guess its quite a unique situation as tube feeding meant my only option was to express so its pretty obvious how much fluid he was getting.

I'm just wondering if it happened again, would you ignore instruction from the paed?

[sheeplikessleep]

Just to say my DSs jaundice got progressively worse days 2-5 (when he then went on the bed). I spent 3 days stressing/feeding (unsuccessfully) and he gradually got worse, got an infection, sleepier and sleepier. I can't help but think that if I'd given just maybe a cup or two of formula, it may have addressed the jaundiced, so that it didn't get to the point where he had to be tube fed and on a bed.

I am pregnant again now and if I had the same, I would be expressing like mad (as I did last time), but would introduce formula earlier if I needed to temporarily.

Not sure if this helps, I don't know the official answer.

[tiktok]

earplugs - my understanding is that a lot depends on the severity of the jaundice and the impact/effectiveness of the lights treatment. Severe neonatal jaundice, untreated, is dangerous. It would be mad to ignore the paed, but perfectly acceptable to discuss it....is my baby's jaundice severe enough to warrant supplements? How long for? What if I manage to express a lot of colostrum?

[tiktok]

Frequent feeding from the very start of life, baby kept close to mum so actually wants to feed often, will increase volume of colostrum getting into baby....so prevention like this is good.

[phdlife]

agree with tiktok.

I got very very bolshie with the registrar who wanted to do more bloodtests on dd and (after she got over her shock at not being immediately obeyed) was basically using scare tactics to try and make me comply instead of, y'know, facts . (This was after dd had completed light therapy and was much better looking.)

Which is why we met the head of neonatology . He brought some lovely graphs to show risk of dangerous bilirubin levels. The only thing I remember at all clearly was that the baby's age mattered - he wasn't worried about dd because she was 5 days by then.

[earplugs]

Thanks everyone for your replies. Tiktoc yes, that does sound like the sensible thing to do. He was in SCUBU because of it and I was so terrified, it didn't occur to me at the time to even think about asking (TBH if they told me painting myself green would have made him better I'd have done it without asking why!) I still am not even sure what they based the milk volumes on that he was given but it was a huge amount that I'm sure you'd never have got into a baby of that age unless they were being tube fed!

Its only with the benefit of hindsight that I'm wondering about it. Brill to know that there are other options though circumstance depending!

[determination]

I thought this link was fantastic for you earplugs..

www.babyfriendly.org.uk/pdfs/hypo_policy.pdf

[determination]

www.babyfriendly.org.uk/pdfs/hypo_policy.pdf