Jaundice treatment in a Baby Friendly hospital - advice needed!

[QueenOfFarkingEverything]

Friend has a baby 4 days ago. He's been put under lamps for jaundice and she is only 'allowed' to get him out to feed for 10 mins every 3 hours.

That cannot be right, surely, in a BFI accredited unit?

doesnt sound right. DD had jaundice and I got her out from the lamps whenever she cried and wanted fed.

If the baby has dangerously high levels of bilirubin then this would be correct and as per NICE guidelines. Your friend will be encouraged to express and I assume baby is being ng fed expressed milk?
Sometimes life saving treatment comes first and I am the biggest breastfeeding advocate.
Hope he recovers soon.

She's struggling to establish BF now and in tears as they are telling her she can't get him out when he is crying.

I want some kind of written policy on how it should be handled for her to wave at them, as this cannot be right.

He has had one blood test for bilirubin levels which apprently came back 'borderline'?

NICE guidelines for neonatal jaundice should help you, must be really hard. My son was seriously ill with bronchiolitis at 8 weeks and was in a head box. He was too sick for even NG feeds, it was heartbreaking not being allowed to feed or even touch him. I expressed for nearly 10 days to keep supply going and it nearly killed me. However he's still breastfeeding at 3.
There is hope with good support.

That doesn't sound right at all and there is a sdpeciasl kind of blanket that the baby can be wrapped in that does the same thing as the light box.

Is baby being tube fed as that ius not enough feeds for a baby that age.

Doesn't sound right. You sound like a good advocate for your friend. Hope the baby recovers quickly.x

This happened with my dd and I remember putting her in the light box thing with her eye mask on and tears rolling down my face. My milk was just coming in and it was awful. I was told only to bring her out for quick feeds and top up with formula. Tbh, I quietly did it my own way. I feed her with as much as would take and took her in and out whenever she needed me. Thankfully she only needed 2 days in it so maybe the constant feeding did the trick.
It's so hard , you are so tired and worried sick.

Unfortunately it's important to get his bilirubin levels down and the more time he spends under the light the better. It sounds fairly standard. If a baby is unsettled/crying then I'd encourage the mum to try and comfort/settle the baby with baby still in the cot. So talking, stroking, hand holding. If that didn't work then yes, out the cot for a short cuddle to see if that works.

But if it didn't work there would come a point where going back under the light is more important. Though to be honest I can't remember a jaundiced baby ever been that unsettled. They're normally more settled than the other babies, to sure if its because of the blindfold!

Jaundice can kill. A borderline reading might not sound much it its still over treatment level. The cut off is there for a reason. If untreated the readings will just go up.

A breastfeed would normally last longer than 10 mins though. Are you sure they said 10 mins only, they shouldn't be restricting a b/f by time. It can take a new baby that long to get latched on!

And not all units have the bili blankets. If they had them I'd have thought they'd be using them.

Many units have them but time you have to ask, it won't hurt for her to ask.

Not time, ime you have to ask.

I have found info from a leaflet online that says this (freedom to feed seems to depend on the light therapy given):

Single light source

If the doctor or midwife recommends that your baby needs treatment for
jaundice, your baby should be treated using a single light source. The
treatment may be stopped from time to time for up to 30 minutes so you
can feed and cuddle your baby, and change their nappy. You should be
given help with feeding. If the bilirubin level is very high or rising quickly,
your baby may need to be treated with continuous multiple phototherapy
straight away (see below).

Fibreoptic phototherapy

Fibreoptic phototherapy is another type of phototherapy. Your baby lies on
a blanket or pad through which light shines.
Fibreoptic phototherapy (if it is available) or light phototherapy can be
used to treat jaundice in premature babies.

Continuous multiple phototherapy

If your baby?s jaundice does not improve after light or fibreoptic
phototherapy, your baby?s treatment should be stepped up. The healthcare
team should offer continuous multiple phototherapy. This involves more
than one light and often a fibreoptic blanket at the same time. During
continuous multiple phototherapy, it is not usually possible for you to
carry on breastfeeding. During this treatment, you can express milk which
can be given to your baby. Your baby might need milk by tube into the
stomach, or rarely, a drip for extra fluids. Your baby can be breastfed
normally again once multiple phototherapy is stopped, and you should
get help with this.

My DD had jaundice and basically slept on a lightbox for 5 days. She was just below the blood transfusion treatment line. I had to feed (breast/expressed/formula top up) every 3 hours. There was a certain minimum amount I had to give her, I can't remember now. But the advice about leaving her in as much as possible was given to me, they did it nicely but yes the same as your friend they told me to put her back in if she grizzled.

It was a horrible way to start motherhood, but DD thrived once she got home (after 8 days) and I did manage to get back to exclusively breastfeeding so it can be done. (and she can self-settle like a dream)

Have checked with her and they have definitely said only 10 minutes feeding every three hours, and no, they are not suggesting she expresses as well. I've suggested it and she is going to ask if they have a breastpump.

p,s, dd wasnt under a lamp and didnt have goggles - she was in a blue blanket thing that velcroed into a cot that had the light shining from underneath - and she cried a lot too!

www.nice.org.uk/nicemedia/live/12986/48680/48680.pdf

Ok, she's asked for a breastpump and been told there aren't enough to go round and that she won't have enough milk to express yet anyway (I'm relaying info as I get it via FB here)

Call La Leche. In the The Womanly Art of Breastfeeding they say that it is possible to hold baby and have treatment at same time (sorry have lent my book out, can't check on it). This is one of those times to make a nuisance of yourself. Find out if the hospital have a Infant Feedng specialist person, often you have to push to see them.

Ask your friend to ask to speak to the breastfeeding/lactation lead midwife tomorrow. She can ask her for advice as 10 minutes doesn't sound long enough.

Though hopefully baby will be off phototherapy tomorrow if baby was only borderline.

Ok, then tell her to ask a midwife to show her how to hand express. There is an argument that hand expression is better until you can express amounts over 10mls. But on day 4 her milk should be in and I'd have thought she would get more than 10mls off. But hand expressing will help.

Also there doesn't need to be an actual pump per person who needs it. There needs to be a kit per person. We don't have enough pumps, but the kit which touches the breast is obviously individual. So everyone has their own kit and the pumps get moved about. Not everyone will be pumping at the same time.

WRT expressing: DS2 was in NiCU for 8 days. I was told no pumping till day 4, but to hand express till then. Even with a heavy duty pump I only managed about 30ml every 3 hrs by day 8. This milk should still be able to be put down the NGT and your friend should google "comfort holding". Also google "bliss" for more info on life on NiCU.

Right they obviously know f all about breastfeeding then.

She can hand express (I found this easier than a pump), videos on Youtube. Use a syringe to collect if its still colostrum.

I had a similar experience with DS (in a baby friendly hospital in Bristol) and was told to keep him under the lights as much as possible and feed 3 hourly but not limited to 10 minutes. It was horrendous and DS cried, I cried. I have since seen photos of a baby being treated for jaundice in the mother's arms, with the light just over the mother and baby - if another child of mine has jaundice I will definitely ask if this can happen.