When is jaundice in a bf baby a problem?

[ShowOfHands]

DS is 2 weeks old, born at 37 weeks. He has been jaundiced since day 3 and it is slowly going. It only affected his face and chest and wasn't severe, now just his face. A slight tinge to his cheeks is all that's left.

The midwife is coming today to 'formulate a plan' as she's not happy it's hanging around this long.

Just wondering what that plan should involve if anything? I'm not introducing formula. He's bfing well, lost 3% of his birthweight and has gained rapidly since. He put on a pound last week. He's happy, alert and weeing/pooing well.

At what point is it wise to consent to bilirubin checks? The hospital is 45 minutes away and I don't drive. I will obviously take him if it's recommended but just wondered if anybody else had any more info?

DD had jaundice too and it slowly went but she was summer born and that helped. DS has been born into a delicious autumn. Pretty too look at yes, but it's not clearing the jaundice as quickly.

DD still had slight jaundice at 2 weeks and my mw didn't think it mattered at all. I just bf her through it and plonked her outside or by the window in her pram all day.

It doesn't sound like it's a problem, but some MWs do latch on to perceived problems where there are none.

I consented to blood tests because the MW wanted me to give formula to "wash out" the jaundice, which I found out later is shit advice and many hospitals actually just give extra fluid in the form of water. I told the MW we would make an informed decision once we got the blood test results. The blood tests showed that the jaundice was not severe enough to worry about so it shut up the midwife and got her off my back.

You can bf whilst they take the blood - DD didn't even notice.

It is most likely nothing to worry about at all. Definitely no reason to introduce formula if breastfeeding is otherwise going ok and he's gaining weight as breastmilk jaundice is normal, harmless and will go away. However, it is really important to get a few blood tests done if a baby (breast fed or not) has been jaundiced for more than a couple of weeks as there are a few conditions that present with prolonged jaundice. The blood tests basically rule out these conditions and I can only think of maybe 2 occasions in my career (bearing in mind we see maybe 4 or 5 babies a week if not more for prolonged jaundice screens) where it has picked up something. However, one of the (very very very rare) conditions it screens for is something called biliary atresia, where there is a problem with drainage of bile from the liver. The earlier this is picked up the more successful the procedure to fix it and if it is detected after about 2 months of age the child almost inevitably needs a liver transplant. The earliest sign is prolonged jaundice and it can be completely ruled out with a very simple blood test - this is the main reason we do the tests when we do.

So if your midwife does want you to get bloods done - please do so. However, they will almost certainly be completely normal so there is no cause for concern. And definitely no need to stop breastfeeding/introduce formula!

to not too. Gah, I blame David Cameron.

I bf through the heel prick test, he didn't notice. His priorities are already set.

I don't mind going for the level to be checked if mild jaundice at 2 weeks is of concern but it's ££ for a taxi and I have a school run to do as well. My gut reaction is he's fine and I want to wait and see but obviously don't want to go against recommendations. DD was checked as she was sleepy and struggling to latch. Her levels were really low and hers was probably far more noticeable. Paed at the time was unconcerned and said it was normal when bfing. This was 4yrs ago though.

x posts sally. Think I have to go then.

worldgonecrazy - the shitness of the midwife's advice does depend on the age of the baby at the time - jaundice in the first few days can be worsened by dehydration and severe jaundice in the first week of life can lead to long term problems - so if it was in the first few days, the baby wasn't very very jaundiced but your milk supply hadn't come in fully yet or the baby wasn't latching on well, adding a little formula til the milk had come in could acually prevent a hospital admission to treat the jaundice (we do sometimes use IV fluids but not extra fluids in the form of water as in a very youg baby this just fills their tummy up with water and no nutrients/salts etc) - so if this was the case it wasn't necessarily shit advice.
However if it was in a baby more than a week or 2 old who was feeding well but just a bit yellow still, this jaundice is generally completely harmless and doesn't need 'washed out' - if this was the case it was shit advice!!

As you said though - the bloods enable you (and us as doctors) to make an informed decision about what to do, they don't particularly bother tiny babies who can breastfeed (or sometimes even sleep) through them and results are available within hours for the majority of the tests we do

I have of course just googled biliary atresia. Why do I do that? Why?

Show of Hands - if your hospital is anything like the ones I have worked in it is literally a case of going in, getting the bloods done then going home and you will be phoned with the result. Also, unlike doing bloods for jaundice in a sleepy, poorly feeding few-days-old baby, bloods for a prolonged jaundice screen, although important, don't necessarily have to be done now this minute, just within a few days. So if there's someone who can give you a lift to the hospital in a few days time but not today - that should be ok (depends on your hospital though - I would be ok with it as long as I knew you would definitely come when you said you would!) rather than spending a fortune on a taxi!

And it has to be done in hospital? Problem is that dh (police officer) is in court all week and my parents fly to Greece today. They're my two chances of transport outside of taxis.

This is why we do these tests though - things like biliary atresia are very very rare but they do happen, the initial treatment is effective but only if done early, but all paediatricians are paranoid!! One of the blood tests we do in a prolonged jaundice screen (which takes a couple of hours to come back) completely and utterly excludes any possibility your child has this condition. If me mentioning things like biliary atresia on a thread like this makes enough mums google it and think 'well, I had better go to get those bloods done, even though it's a hassle and I'd rather not', you never know, a case may be picked up early and a child who would otherwise have needed a liver transplant will be treated successfully! (obviously the likelyhood is that your baby's bloods will be completely normal and all will be well - but you will feel all glad that your baby doesn't have biliary atresia, rather than pissed off at having to pay for a taxi and waste your day having some pointless blood test cos the midwife is a pain in the arse!!)

Ask your GP - we do need a reasonable amount of blood usually, ie a little more than a heelprick, your GP may or may not be able to do a venous sample on a baby. It doesn't necessarily have to be done in hours, check with your paeds ward - they may be able to do it in the evening for you after your dh has finished work

The midwife is utterly lovely. I do trust her but also like to know exactly how and why they do things.

Chances are he's fine. He has no symptoms of any liver problems outside of v slight jaundice. In fact in this light you can't see it at all.

I'll await the midwife and see what she says then.

Hi,
I just thought I'd add my experience, DS1 was jaundiced from birth and spent his first week going through numerous blood tests and in and out of the UV 'billy' bed. The nurses immediate concerns were that he was getting dehydrated as he stopped producing dirty nappies so we did give him formula top ups (which are not the work of the devil) but after that first week I breast fed til about 8 months However your DS doesn't sound like he's dehydrated so I wouldn't be thinking about giving him formula unless it was absolutely necessary.

The blood tests were to find out if it was relatively harmless 'breastmilk jaundice' or something wrong with his liver so I think it is important to get the test done just in case. It turned out that it was just breastmilk jaundice and he continued to look yellow for about 3 months after (with occasional checkups at the hospital. Apart from that it seems to have done him no harm at all and now he's a boisterous 4 year old settling into reception class at school

I'd get the test done if you or the midwife are worried, its very quick and it'll put your mind at rest.

The Cub was born at 35 weeks and had pretty bad jaundice, he ended up in light box for 4 days.

At his 6 week check we were referred back to the hospital due to still having some yellowness - my dr wrote a letter saying he was ff not bf and loads of other things happened which made it longer than it needed to be. Basically they checked to see if it was conjugated or not - it wasn't.

Best to get it checked if it's a worry imo.

HopeEverythingGoesWellTiggaxx

DS was jaundiced from birth and it was a bit of a problem, but only because (in hindsight) bf wasn't going well. He lost over 10% of birthweight and was pretty yellow and skinny by the time he was hospitalised when he was 5 days old. Can't fault the hospital tho, he was in a light box for 24hrs with me feeding and expressing like a mad woman, then we were in for another 2 night while bf got better established.

A HV came to see us at 4 weeks and terrified me completely by saying that he was still 'noticeably jaundiced' (she'd never seen him before and we of course were comparing him with how yellow he had been, at 4 weeks it was more of a tan than Simpsons yellow...).

So we went and had the standard blood tests and all was well, as others have said better to check. I wish the HV could have phrased it that way at the time.

Hope all is fine with your DS too.

The midwife was unconcerned. Said the very, very slight tinge was barely noticeable and wasn't an issue. She's coming back on Fri just to be doubly sure but she seemed remarkably unperturbed.

All good then SoH - bet it will be completely gone within a week.

DD weighed over a pound less than DS and lost 13% of her bodyweight so with jaundice on top I was a bit of a nervous wreck for the first week or so after she was born, but it all came good - she now weighs more than DS did at the same age.

Bit late to this, but DD got referred by the MW at 2 weeks. By the time we got the appointment the jaundice had almost gone, apart from the tip of her nose, and all the Docs were asking why we had come in . They did all the tests anyway and they came back fine.
However, when the Paed listened to her heart he found a heart murmur that has turned out to be Atrial Septal Defect and Mild Pumonary Stenosis. So it was worth going!

@sallysparrow157

I am so sorry to open up such an old post.
My little one started showing symptoms of breast milk jaundice a week ago and one of the things I am most worried about is what you have described biliary atresia.

Would you mind telling me what the test is?
They have done, bilirubin (which is quite high), fbc and tft which were normal but is there something different to check / rule out biliary atresia?

Hi Belle82, to rule out biliary atresia they basically look at the fraction of conjugated vs unconjugated bilirubin - in normal baby jaundice the bilirubin is mainly unconjugated but in biliary atresia the level of conjugated bilirubin is proportionally higher. This isn’t a test they will normally request unless they’re doing a prolonged jaundice screen but they may have already tested it on the bloods your baby has had taken so it’s worth asking whether it’s been done just for your peace of mind. Breast milk jaundice is extremely common and biliary atresia extremely rare so hopefully all will be well with your little one

@sallysparrow157
Wow, thank you so much for coming back to me and so quickly.
I will look into the results of that test. Again thank you 😊

Hi I am sorry to come back to this topic but today after going to A&E as my 4 week old daughter still had some yellow tinge around her nose, blood tests showed low level of unconjugated bilirubin but high level of conjugated bilirubin at 23%. Her stools are mustard colour and wee is colourless. They referred us for more tests and ultrasound tomorrow but these hours are agony. Apart from biliary atresia, what else could be causing these elevated levels? I'm trying to keep positive but I cannot find a scenario where it could be nothing. Any info or experience would be extremely helpful.

@sallysparrow157 I am sorry to come back to this topic but today after going to A&E as my 4 week old daughter still had some yellow tinge around her nose, blood tests showed low level of unconjugated bilirubin but high level of conjugated bilirubin at 23%. Her stools are mustard colour and wee is colourless. They referred us for more tests and ultrasound tomorrow but these hours are agony. Apart from biliary atresia, what else could be causing these elevated levels? I'm trying to keep positive but I cannot find a scenario where it could be nothing. Any info or experience would be extremely helpful

No advice personally @TLondon88, but tagging the incredibly helpful and knowledgeable @sallysparrow157 in the hope she's still about. I have everything crossed for your little one