HV overreaction? Or a genuine concern?

[AmandinePoulain]

Dd2 is 11 days old today, born at 37 weeks, birthweight 2.98kg. Her weight on day 3 was 2.80kg, it was 2.86 on day 5 (measured by community mws) and today I saw a HV for the first time and she's 2.92, so gaining weight but not back up to birthweight. The HV seemed concerned by this, I wasn't until she was! I'm a SCBU nurse so probably should trust my own instincts and knowledge but it's not the same when it's your own!

She latches on and feeds well, she'll go anything between 1 hour and 3 between feeds through the day, with probably at least one period of cluster feeds through the day. At night she was going 2 hourly but the last 3 nights she's gone 3 hourly. She feeds for 10-20 minutes each feed, sometimes she needs both breasts to be satisfied, sometimes not. She tends to drink so much she possetts with wind after most feeds, I'm not sure I could physically fit any more in her! She has plenty of wet and dirty nappies. I have suffered with cracked nipples but they're getting better, her latch looks really good to me.

The HV also seemed concerned that her head circumference hasn't changed since birth, but when I just measured it I got a 0.5cm larger measurement , and that she's jaundiced. If she still is on day 14 she wants to refer her to a paediatrician. Her levels before we left the hospital were below any treatment line, and I think she looks less yellow now than then.

Should I be worried or is the HV overreacting?

I'd say go with your instinct. If there are plenty of wet/dirty nappies you can't be going too far wrong!

I think everything sounds great!!! HVs do tend to panic if babies don't follow their charts :) if she seems ok alert content and is feeding well then just keep eye on her

We were referred to a paediatrician at about 10 days for similar reasons - mild jaundice and slowish weight gain. The doc was completely unconcerned about her and told me to just keep feeding on demand. It was quite reassuring to hear.

So don't panic if you do get sent to doctor.

From what you've said (and given you are a nurse!) she sounds fine (not dissimilar to DS at that age) - did they all use the same scales? DS was measured by one visiting midwife on what amounted to a set of hanging luggage scales (spring and pointer and all), by another on a digital set she sat on my coffee table, and by a third on the carpeted floor with digital scales

She is gaining weight, she is producing nappies, she sounds normal, if you're still worried take her to the GP or into the clinic and get her measured on a proper, calibrated set of scales.

Thanks. They all used different scales, but all digital. My mum just pointed out that she was only 37 weeks - one day earlier by my dates and she'd have been counted as being premature! She's only on the 9th centile so she's only tiny, she's just woken for another feed an hour after her last one so she obviously wants to catch up .

I'm seeing my mw on Friday, she seems much more sensible so I'll go with what she tells me

Congratulations on your new dd!

Ds is 3 weeks old, 11lb 2 and under Drs for jaundice. He is currently plotting the 91st centile and is troughing for England! The dr doesn't seem to worried as he is feeding, gaining weight, weeing clear and having fluorescent poos!!! He's had 2 blood tests to monitor his bilirubin levels, last week it was 90, today 71. Have been told we will have to have weekly blood tests until the levels drop below 25.

They say that jaundice after 3 weeks for a prem baby is a worry so as your dd is on the cusp it may take her a little longer to expell the haemaglobules that cause the jaundice. When I went drs last week he didn't even check him as he was asleep, just asked what I thought as his mother!

I'm sure everything is fine and with the knowledge you have, trust your instincts!

DS was jaundiced until 10w. The MWs and HVs kept a close eye on him but other than advising plenty of sunlight, did nothing. He was gaining weight incredibly quickly (up from 8lbs9 at birth at 39w to 9lbs at day 5, 9lbs11 at day 14). He was BFing constantly, plenty of wet/dirty nappies. I was told that mild jaundice in breastfed babies can last quite a while and not to worry about it if the baby had wet/dirty nappies and gained weight consistently. Same HV team hospitalised my friend's baby a few weeks later due to jaundice - no weight gain, dry nappies, increasingly yellow - so clearly they aren't just super-relaxed/negligent.

I'd go with instinct. Some babies are quick out of the blocks, others are slow starters. In your case I'd also trust my professional judgement, bet you've seen enough sick babies to recognise one.

At work we wouldn't be concerned until 21 days, but our babies have regular bloods that tell us the level of jaundice as well as a detailed breakdown of the type of jaundice. Dd hasn't had any bloods, before we were discharged the dr used a bilirubinometer on her (a new machine that uses light to get a reading rather than subjecting well babies to bloods). I haven't been worried at all until she was, dd1 was exactly the same (jaundice wise, she gained weight quicker) and no one was concerned about her!

Thanks for the replies

How would I find out if our hospital has access to a bilirubinometer? Would prefer them to use that than keep having to listen to him cry when having bloods each week

We've only just started using them, and they can only be used on term babies over 24 hours old - I'm not sure if there's an upper age limit. Is it just a standard SBR they're doing on him? It may be that they want more detailed bloods, the monitor can't break the result down into different types of bilirubin, which might be what they need. Worth asking though!

Thanks, I'll try maternity ward tomorrow to see if ours has one

I wouldn't worry about the weight unless not are concerned that she's not feeding well (and you said she is feeding well). I can't offer any advice on the jaundice as I haven't experienced that, you prob know far more about it than most of us :)

My son was born at 38+1 same weight as your DD, he had dropped to 2.73kg by day 5 and they nearly wouldn't let us out of hospital, talking about this ten percent figure, then I managed to get him up to 2.84kg by 10 days and eventually back to birth weight by 2 and a half weeks. So don't let them bully you with regard to her weight at this point, as long as you are still sure that feeding is going well, it sounds like she is making her way up the scales in her own time. Hope this helps x

So our SCBU have the equipment but it can't be used to test for pro-longed jaundice so it's back to the weekly blood tests til it has gone :0(

Thanks Amandine for mentioning it, I just spoke to a lovely Dr on SCBU and it was worth a try!

My MW has just been. She was unconcerned about her weight, in fact she didn't even want to weigh her! But she spoke to a paed about the jaundice and we need to go for bloods this afternoon . Bloods that I do all the time at work but she's my baby

weight can differ if different scales / on a different surface it is only a few grams usually but these grams make a huge difference to baby's trust your instincts but obviously do what hv / doctors say....if it makes you feel bellet my 18month dd2 isn't 8kgs yet (not entirely convinced she ever will be) and is perfectly healthy

Oh AP, I know exactly what you mean. I'm also a SCBU nurse and my LO who is now 6 months was still in hospital and jaundiced at 12 days. They had no hand held bili monitor so she was having bloods every day. It broke my heart!
I kept thinking, ''I do this everyday, what's the matter with me!''. Totally different when it's your own. I'm a mess as a mother half the time!

diddic I'm the same with immunisations! It's the look on their face, the confusion that you are letting someone hurt them!

I'm waiting to see a dr but she's just gone on the scales and weighed...3.08kg! So either my HV is a loon with duff scales or she's gained 160 in 2 days!