Calling Mears - advice about possibility of severe physiological jaundice occurring in baby number 2

[popsycal]

Wasn't sure in which topic to post this thread. I am around 7 months pregnant and am beginning to worry about a repeat situation as I had when DS was born two and a alf years ago....

Was induced around 38 weeks due to pre-eclampsia. Birth very straight forward - no assitance etc. Day 3, DS developed very high levels of jaundice and spent time in SCBU receiving triple phototherapy...then 2 weeks of double and single phototherapy on the ward as the bilirubin levels would not go down. He was very close to needing exchange transfusion (and with research I have done recently, his levels suggested he should have had a transfusion). In the end, a shot of phenobarnitone (sp??) kick started his liver just as they were going to call in a specialist.

We both had all the tests under the sun - no blood incompatibility or antibodies....nothing at all. Did all possible tests on us both and nothing. 'Severe physiological jaundice - cause unknown'.

he had a hearing test at 4 weeks (as the levels were such that hos hearing could have been affected) and he was fine.
He is now a groegous, chunky two year old.

ANyway - I am beginning to worry about baby nummber two. Is there any reason why this should reoccur? And is there any thing I can do to help to minimise the risks?

Thanks in advance

[popsycal]

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[Yorkiegirl]

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[maomao]

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[Frizbethereindeer]

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[Newbarnsleygirl]

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[TumbleflumpDancingBum]

The normal infant Jaundice Incidence

Very common. About 50%of full-term infants and 80% of preterm infants are visibly jaundiced by 3 ?5 days of age.

Pathology ?Early jaundice occurring within 24 ?48 h of birth is usually due to abnormal haemolysis,infection,or bruising.

?Physiological jaundice appears after 48 h of age and usually subsides within 7 ?10 days.It is mainly unconjugated bilirubin due to increased red cell destruction and immaturity of hepatic enzymes.

?Prolonged jaundice lasting beyond 14 days is sometimes seen in normal preterm or breast-fed infants, but other conditions should be excluded, especially hypothyroidism, galactosaemia,liver disease, red cell enzyme eefects and biliary atresia.

Clinical Yellow staining of the skin and conjunctivae. features Hepatosplenomegaly indicates the presence of abnormal haemolysis,infection or a metabolic disorder and is not found in physiological jaundice.

Significance Very severe unconjugated hyperbilirubinaemia may cause permanent brain damage (kernicterus)with athetoid cerebral palsy and sensorineural deafness.

Management Observe jaundice clinically and monitor plasma bilirubin level. Investigation may be required if jaundice appears earlier than 48 h,is prolonged beyond 14 days or is unusually high at any stage. Dehydration and drugs such as sulphonamides, which compete with bilirubin for albumin - binding, should be avoided.

There is no evidence that extra fluids are needed or hasten the resolution of jaundice in normal infants.

Phototherapy or exchange transfusion may be required in some infants with high levels of plasma bilirubin. Some jaundiced babies, particularly those with severe rhesus haemolytic disease develop a curious bronze colour under phototherapy.

[popsycal]

thanks for bumping this up for me ladies!
And thanks tumbleflump for the info.....

MEARS!!!!
Where are you!

[mears]

Hi Popsycal - really is a difficult one to predict. Depends when you deliver in a way. If this pregnancy goes on longer, baby's liver will be more mature and jaundice may be less. Because there were no antibodies or incompatability it is difficult to say how you could minimise the risks. I know the levels for exchange transfusion are actually much higher than the charts suggest, so it was probably safer not to do an exchange. There are risks with that but as you may know my DD had 3 exchanged with no problems at all. I think probably is best to know that this baby will be monitored closely postnatally, with jaundice being treated if it becomes a problem. Sorry I have no gems of advice for you. Try not to worry too much about it - all babies are different. There is nothing to suggest it will happen again. HTH.

[popsycal]

Thanks Mears - that os basically what I thought too....I am going to have a chat with my midwfie actually as I really want breastfeeding to work but am so paranpid about dehydration etc....it is also quite possible that baby will be induced early this time too....

[mears]

As far as breastfeeding is concerned, baby should not get dehydrated with frequent feeds. If you do have a sleepy baby it is ensuring that you express at least 3 hourly and give baby any colostrum/ milk obtained. Despite having 2 babies who were jaudiced, the last one needing transfused, I never had a problem establishing breasfeeding. Baby number 3 needed ventilated for a week because he was 5 weeks early so I established milk production by expressing. He was about 10 days old before he got near the breast but thankfully he knew what to do. Babe no. 4 fed straight after delivery but once admitted to SCBU wasn't allowed to feed until after her tranfusions. She was about 5 days old before she got to the breast again, and again remembered what to do. Once again I got the milk in by expressing regularly. Hope that is some reassurance to you.

[mears]

DD was 2 days short of 38 weeks by the way.

[popsycal]

thanks again mears!
ds fed beautifully but was a really sleepy feeder.....I will definitely go for very regular feeding

thanks again....
no doubt i will revive this thread nearer the time