jaundice and not feeding well - help needed!

[sweetkitty]

DD is 4 days old and we were discharged from hospital only to return the next day. She never fed well from birth and is a very sleepy baby. She had jaundice so we had to go in overnight and she had phototherapy, they kept measuring the levels of bilirubin in her blood and they came back down to normal so they let us out. I was breastfeeding but she has never been that interested. I expressed for her in hospital and she seems happier taking it from a bottle. She is lazy and just lies with the boob in her mouth a lot.

She was taking about 40 mls of EBM and some off the breast but now this has went down to about 25mls and it takes me ages to get her to take that. She's still peeing and pooing well though but is still very sleepy.

Has anyone had experience/advice?

Hi Sweetkitty, congratulations on the birth of DD. I went thru something very similar with DS (Steven). Physiological jaundice - i.e. jaundice just after being born, rather than due to liver or other metabolic problems is very common, and if it only took 1 day of phototherapy to improve, it sounds like it was pretty mild. TBH if DD is being sleepy and showing less interest in feeds, I would try and get her seen by a midwife tomorrow, in case the jaundice is coming back, tho it is good news that there are plenty of wet and dirty nappies. 4 days is still very early tho in terms of DD getting shut of the jaundice, so I wouldn't worry too much if she is getting a bit jaundiced again - but the midwife may want to do another blood test just to check that your DD needs no more phototherapy.

My experience was: struggled to establish BFing whilst DS was under the lights for 4 days, left hospital when DS was 8 days, feeding started going pearshaped again about a week later,DS was looking yellower, and didn't produce a dirty nappy in 24 hours, and a wet nappy in 12 hours - DS was then admitted to hospital again at 2 weeks for 3 days - his bilirubin levels were 260 - too high, but not high enough to need phototherapy. DS was also a bit dehydrated. Because DS was just over 14 days old, the hospital protocol was to run tests for liver/metabolic disorders, because theoretically babies should be rid of physiological jaundice by 2 weeks old, and they wanted to keep him in for observation in case the bilirubin levels got any worse. The tests all came back fine, but by that point I had lost confidence and bfing, and fed him either with EBM or formula. The nurses tried to feed DS by gastronasal tube, but he took it out, so I let them give him a bottle - one go at the bottle and he never looked back! I had lots of noble intentions to purely express once I got home but was just too knackered, and ended up formula feeding. DS is an incredibly slow feeder - can easily take 1 hour on a bottle, so in hindsight I think that he just couldn't get the breast milk quickly enough when bfing so i think it would have been incredibly difficult to bf him successfully.

best of luck, and sorry if this is incoherent

Sweetkitty - she will eventaully click about what she needs to do. It might be better to offer her EBM from a cup. We have cups for cupfeeding supplied with out breastpump kits. Can the midwife give you something similar? If not the top of a feeding bottle will do the job. Babies actually cupfeed very well and it doesn''t take as long as you think. It actually means they are more likely to suck when fixed to the breast by not getting used to a teat. Encouraging skin-to-skin contact as ofetn as you can may encourage her to feed. Until she does start to B/F properly, keep expressing to stimulate your supply. Does the hospital have a B/F counsellor who could help? If not, what about local helpline numbers. The midwife should be able to give you a list. Hope she turns the corner soon for you. Congratulations on her arrival

Thank you so much mears and everyone. She had a BF only feed today. The thing is I don't know how long a "normal" feed should be, she started off fast and furious for about 5 mins then slowed down and rested in between (is this her getting at the hind milk)? She stopped after about 10 minutes. When she bottle feeds she only takes about 40-45mls every 4-5 hours - is this enough for her. She is pooing and weeing well.

I haven't tried cupfeeding I will ask the midwife when she comes tomorrow. I am offering her the breast every few hours before topping up with the bottle if I think she needs it. It's just that she is still very sleepy as well. I thought babies were supposed to be up and screaming all the time but she is so quiet and content.

Sorry I am waffling just an anxious new mum.

We too had this problem with DD3, and because my best friend was a midwife (though she too was on maternity leave when I had DD) I was prepared for all the intervention the hospital was going to offer, but at the same time didn't really want to accept it. We had to go beck in when DD was 1 week old, but I managed to stick to my guns regarding offering a bottle and was adamant I'd only breastfeed. In the end they did respect this and just by offering little and often we did get through it. I was supported by the hospital midwives - I got the distinct impression that they were telling me to give a bottle only because they had to. When they saw I wanted to bf they were fine and encouraged it. We were given lots of complicated things to get urine samples when we were discharged from hospital, and had to go back for loads of blood tests, which was the payoff for not agreeing to bottle feed (and therefore be able to tell them exactly how much fluid she was taking in). I think the main indicator is wet nappies - seek the midwife's advice if you haven't had one for a few hours.

It's dead hard to know whether to follow your instincts or go along with medical opinion in these things, isn't it? Midwives often have to cover themselves by only advising what would be applicable in a 'worst case' scenario. I'd say really try to go along with what you feel is right. Jaundiced babies are always sleepy , but if she is waking and feeding - even for 5 minutes - every couple of hours, that's probably enough. Just believe that what you think DOES COUNT, what you want to do DOES MATTER and ask for a midwife visit every day.

Good luck, congratulations and lots of love xxx

I agree that it would be better to offer ebm from a cup. Ds was very sleepy and jaundiced (he then went on to refuse the breast completely but thats another story). He would just lie at the breast and lick the occasional drip.

I cup fed him for the first month. It was hard but was worth it in the end. I felt that using a bottle would confuse him too much.

It does sound however like she is getting enough if she is doing lots of ppos and wees. There is no "normal" length of feeds. I would be concerned if a newborn wasn't waking at least every 3 hours or so in the day to feed but the pattern of her feed sounds OK.

There are 3 stages to a b/f. The fast and furious sucking (to encourage the letdown), then longer more rhythmical sucks with pauses in betwee finally followed by fluttery sucks. You should ba able to see her ear wiggling up and down when she is sucking.

It may be worth waking her to feed a bit more often. Sometimes sleepy babies can get into a viscious cycle of being too sleepy to feed which means they stay jaundiced and therefore sleepy.

I know breast milk is best and if taken directly from your breast, much better BUT if she is having problems (jaundice and not eating well) I wouldn't risk it and do as the hospital suggested even if that means expressing, giving him milk with a cup, syringe or whatever.

I would only suggest that you try to keep her awake while she is fed to help her to drink a big glup of milk rather than smaller ones, and I would also suggest that she had a feed at least every three hours (wake her up if needed). Once she is "in track" you can relax and do demand feeding, follow a routine, or whatever you choose but I think is a good idea to help her go through this first.

Chandra

sweekitty Milk Thistle is great for helping with jaundice. you take it 3 times a day (maybe twice, depending on brand). Two good brands are Bioforce which comes in drops and Quest comes in tablets, drops will work better. You can get them in any health shop.
You take it everyday until the jaundice clears up. The baby will get enough of it through your breast milk.

thanks for the advice - midwife came today DD had a number of feeds during the night then had one at 9 this morning and one at 1 but she said this was fine. Still having wet pooy nappies so midwife said not to worry too much she is coming again on Wednesday.

Never heard of the milk thistle gloworm I have some in the house already - left over from my need to detox after the weekend days.

Hi there!!!
Congratualtions!!!

If you are still worried tell the midwife and get her checked again! She sounds fine.

DS was in hosiptal 2.5 weeks with severe jaundice. He was well and truely tango-ed!! had to have triple phototherapy and a drip and it was so bad - his bilirubin levels remained so high for weeks then gradually he got better.
He was also a sleepy feeder and special care even gace him a few bottle feeds to get fluids into him.

I don't really have any advice other than speak to the midwife if you are at all concerned. Just wanted to let you know that others have been in the same boat

he is a healthy strapping 2 year old now with no health problems or complications!!

one more thing - they did every test under the sun on ds as the jaundice was so prolonged - loads of weird blood tests and were about to get the top liver consultant in the area to come and see him then the levels just began to go down. it is his second birthday in a weeks time and i am getting upset thinking about it all so I know how you must be feeling.

Trust your instincts and ask for help if you need it
hugs
Popsy
xxx

thanks popsy I just look at how small and tiny she is and worry better get used to it though I'm a mum now!

sweetkitty - sounds like it is all going pretty well - if the midwife is satisfied, then sounds good to me. midwives are very experienced at picking up on jaundice - and they can tell a lot just by the colour of the baby's face (i.e. whether she looks tanned). best of luck to you and dd

Congratulations on DD. She sounds like both of mine. Both were sleepy and jaundiced (bit of a chicken and egg situation) so I had to do a lot of keeping them going when they were feeding.

I kept an eye on the clock and tried to feed every two hours or so during the day and we would take their nappies off, blow gently into their faces to rouse them and make sure they were properly awake. I wasn't very good at doing it (used to upset me!) so DH used to do it. Then I'd start feeding and stroke under their chins to keep them going if they looked like they were nodding off again. It took a few days both times and it's difficult when you are recovering from the birth (and pleased that the baby is asleep) but it is worth it.

Good luck.

sweetkitty I know how you feel. dd was so sleepy for about the first 2-3 weeks that almost nothing would wake her up. I tried bf before every feed and used a haberman bottle if the breast feed didn't work. She eventually got the hang of it. We did a nappy change after she stopped feeding which essentially woke her up and so did her feeds in two parts. She is now 17 weeks and only feeds from both breasts just before she goes down to bed so don't panic about the length of time feeding. It varies depending on growth spurts etc.
You are both doing great to be almost primarily bf already. We had one lady in with the breast feeding consultant who was perservering after 6 weeks of still not managing it.

Hi dino

Sorry to hear things are not quite as straightforward as they should be.

FWIW, my older two both had really bad jaundice, and everyone got their knickers in a knot over it -- and then it just went away. Haven't read the whole thread, but have you tried moving his basket to beside the window and stripping him off to just a nappy? Apparently that's a sort of DIY phototherapy (assuming a nice warm room and not direct sunlight, obviously).

Also dd2 took nearly 4 weeks to regain her birthweight (9lb5oz) despite feeding like a trooper, and is still quite small at 8 months. Sounds as if Blake is feeding fine -- you can't really force-feed him, can you? Maybe he's just going to gain more slowly and that is normal for him.

Hope things improve soon -- there's nothing like health professionals for making you jumpy, though, is there?

Hi Dino, not ignoring you but don't feel I have anything helpful to add - if you have seen my post below, I went through the real interventionist approach - admission to hospital, battery of tests, g/n tube and ended up giving up bfing - however ds was dehydrated, so he definitely wasn't getting enough breast milk directly from him. Best of luck to you, and if he is producing lots of wet and dirty nappies there is obviously plenty of fluid going through him.

dinosaur - read my posts a little further down the thread to sweet kitty.

Please trust your instinct.
Out of interest, do you know what his bilirubin levels are? has he had any phototherapy??

I also meant to ask whether the hospital have done any tests? When did the jaundice develop?

just reading this and realised it was me that started it

thanks to everyone who posted dd is doing well regained her birthweight and another 3ozs the week after the jaundice, took her about 10 days to look unyellow.

dino - i got obsessed with getting milk into her if you are having loads of yellow nappies he must be getting enough, i'm sure he will be fine in a few days

Dinosaur - I just sent you a really long email and it sent it back!!!!!

how odd!!!!

Here is what I sent:

Hi there!

Your post really struck a chord with me as it was a very traumatic time for us. My son was induced at 37 weeks as I had pre-eclampsia, so I was in hospital fora week before he was born. My blood pressure continued to stay high so they would not let me out of hospital which was lucky.

When he was 2 days old, I mentioned to a midwife that he looked very yelllow and that the whites of his eyes were turning yellow. She said 'wait and see' but the next morning he was orange!

They did a bilirubin test and his levels were over 400 so he was rushed to special care, put on a drip to hydrate him and given triple photo therapy. He nearly had to have a blood tranfusion.

After a day in special care, the levels came down a bit (mid 300s I think) and he received double phototherapy on the ward. But then his levels went back up again - not as high, but too high.

I was still receiving medication for blood pressure so we both stayed in hospital. He was a sleepy feeder from the start but I did ask the midwives for help each time I fed him and they did give him some top up formula bottles.

They ran every blood test going on both of us - our blood groups were an exact match, even down to weird little fiddly bits, so that wasn't causing it. They check his liver and kidney functions which were fine.

When he was 2 weeks old, he was still on single phototherapy and his levels had come down but not enough. They were about to call the north east liver consultant to see him but as a last resort they gave him something called Phenobarbitone (which is apparently used to treat epliepsy but can 'kick start' the liver) and thank god that worked.

We were allowed home at 7pm in the evening when he was 14 days old but had to keep going back each day for a few days and his levels went down.

He stayed yellow for about 8 weeks if I remember rightly.

Since the levels were so high, he had to have a hearing test at 4 weeks. he had a check up with the consultant at 8 weeks and 16 weeks then was discharged.

He is now a 2 stone 5 lb two year old who easily hit all his developmental milestones (some of them early).

They said it was 'severe physiological jaundice' - which means there was no known reason why it happened (which bugs me a little!)

I think, personally, it was a combination of him being born a few weeks early and being a sleppy feeder. I must confess that I mixed feed him pretty much from leaving the hospital as I was very concerned about him getting enough fluids. I stoped breast feeding altogether at around 12 weeks - it gradually vanished.

How old is your DS now? is he receieving phototherapy? Let me know if I can be of any more help.
Hugs Popsy

any more news dinosaur??