Jaundice: advised to introduce formula

[Lombriz]

My baby was born at early term (37 +5) and she's quite petite (2.5kg). She's developed jaundice that was picked up by bilirubinometer and we were sent to hospital. They checked her blood and said she's just below the level when treatment would be needed. They told me to top up with formula (she's exclusively BF) , I've forgotten the amount now but the lady said half of her daily intake to be formula.

She's been feeding well and regularly, she wakes up evey 2 hours at night asking for a feed. We have 6 dirty diapers a day and up to 10 wet ones. She looks to me like she's getting enough so I'm very confused as to why I should add formula. Won't it just replace the breast milk? I thought long term benefits of breast milk far outweigh the risks posed by jaundice?

Anyone's been in this situation?

Hospital ones are much more effective apparently - won’t they provide one? If the jaundice is that bad that you need to do it you shouldn’t have to wait and buy your own pump? Has she had to go under the lamps?

You can in fact overfeed a bottle-fed baby; whether the milk in the bottle is formula or breastmilk doesn't really matter. Milk only comes out of the breast if the baby sucks hard enough to make it, but milk comes out of a bottle teat without the baby really needing to try, and some people overdo the flow and/or force the baby to keep the teat in their mouths when they'd otherwise let it go.

This happens if you’re not paying attention. But bottle fed babies give signs that they’re done, that’s for sure. Also, when the baby is jaundiced, I don’t think over feeding is the main concern. Gotta flush the jaundice out.

Hi OP. Sounds like your instincts are correct. Poor feeding can certainly contribute to jaundice and jaundice is a flag to ensure feeding is going well. However, weight and output sounds good, and the bf cafe will hopefully be able to assess a feed. If baby is feeding well, there's no need to increase milk. For increasing milk intake for a bf baby, you don't need to start with pumping- breast compression and switch feeding will help, hopefully the cafe can talk you through this. You can also ask when you see the docs if there is an infant feeding specialist you can talk to.

You think some parents force feed? Wow that's quite the accusation! Are you sure you aren't misinterpreting encouraging a fussy feeder? I've seen some breastfeeding mums having to encourage feeding, I wouldn't label it force feeding or over feeding though.

Lots of bottle-feeding parents will well-meaningly "encourage" a baby to take a bit more or finish the bottle, yes. That's why the NHS recommends paced bottle feeding and not tipping the bottle too high. They aren't trying to punish or force the baby, they are just either distracted or don't trust the baby to self regulate.

There is extensive academic literature on the subject, since rapid weight gain in infancy is predictive of obesity in later life. Watchmaker et al 2020 is one of the papers summarising the relationship between overfeeding of formula and later obesity. There are also papers specifically tracking the tendency of mothers to "encourage" babies to finish a bottle and its association with a) later encouragement to eat beyond satiety cues and b) later overweight and obesity.

Just to add - we were in for light therapy, so my baby had same weight / age as yours but was in a worse position and the supplementary cup feeding worked a charm. I'd never of known about that if I hadn't got lucky with a NICU nurse and a pro breastfeeding health visitor (who sent us to a&e because of the jaundice)
It really can be done if the will is there xx Hope little one gets better soon xx

Re pump as well - if you get admitted they'll be a hospital pump you can use to cup feed between bf. If at home, I found the medula hand pump actually worked the best for speed and output (I originally had the fancy evie one). The most important thing with pumping is the flange size - measure your nipple and get an inset (Amazon!) that size. All of my friends needed an insert as pumps generally have a large flange size so that it fits all and people add a silicone insert in to fit them. Makes the world of difference to comfort and output (and reduces chances of mastitis etc which can be more common with pumping)

These are the inserts I used amzn.eu/d/0go7XAE

Hand pump amzn.eu/d/9paK5BZ

And a really supporting bf person on instagram - her stories have a lot of q&a's saved which I found invaluable over the years www.instagram.com/mamas.milk?igsh=Y2d5Y2p1OGtlcTBp

It's totally do-able you just need to have the right knowledge and support which is sadly lacking so much across the county xx

You can disagree with it but there is evidence and research which backs it up. Like a pp said the baby doesn't have to work as hard for the feed as with b/f, if the milk keeps dripping in the baby will keep swallowing. Yes there are signs but the majority of parents don't notice, plus the signs are quite late. Volumne of a newborn's stomach is 7ml. How many people make up a 7ml bottle feed? This is why formula/bottle feeding is linked to obesity in later life.

The final data set included 1106 infants (547 male; 559 female). 1023 of the 1106 newborns (93%) were overfed at least once during DOL1, while 789 of 1106 (71%) were overfed 3 or more times during their first 7 feeds. After adjusting for birth weight, infants who were overfed 5 of the first 7 feeds were 5 times as likely to be overweight or obese at their 4th year well child check-up (p <0.05) compared to children not overfed. Infants who were overfed on all 7 of their first 7 feeds were 7 times more likely to be overweight or obese at their 4th year WCC (p=0.017). Conclusions: Infants overfed on DOL1 were significantly more likely to be overweight or obese at their 4th year WCC, compared to infants not overfed on their first day of life. Newborn families may benefit from counseling regarding age-appropriate volumes of formula during this critical time period. Future studies will aim to look at effect of implementation of smaller feeding bottle size on reducing overfeeding practices and future risk of overweight and obesity.

Newborn feeding recommendations and practices increase the risk of development of overweight and obesity
Authors:
Brittany Watchmaker
Bridget Boyd
Lara R. Dugas
Source:
BMC Pediatrics, Vol 20, Iss 1, Pp 1-6 (2020)
Publisher Information:
BMC, 2020.

Not to mention breastmilk literally contains a hormone that triggers a baby to know when they are full. Formula does not and cannot contain this.

The usual formula bashing sigh......

I'm a midwife. I would not tell someone to give formula. To a jaundiced baby under the treatment line, or at all if they're weeing and pooing! Just keep feeding regularly, and monitor the jaundice! They poo the bilirubin out, so it makes sense to flush it, but you can do that with breast milk!

Hah! You never met my boobs - milk absolutely flew out far quicker than a bottle so yes you could absolutely have overfed on the boob and lots of bf babies do over feed due to sucking for comfort which they then posset up. An appropriate bottle teat and pace feeding and you would be unable to overfeed without really trying! let’s not turn this into a breast vs formula debate…

I don't have any direct experience but I saw this La Leche League article shared the other day and some of it might be relevant/reassuring.
https://laleche.org.uk/jaundice/?fbclid=IwY2xjawITajdleHRuA2FlbQIxMQABHcxyhKvKgKTWXaKTOmXAUsB4ih1JjstJEhuzAfctrr4U1AbgfQQGzzr8Kg_aem_3m6wCRZ-685Xy7i1DyohDw

Hi OP. Hope your day has been OK.

Both my babies have been jaundiced - eldest in particular was quite unwell with it and needed admission at 7 days old and phototherapy for several days. Neither of them ever had formula and I was never advised to give formula. I was told to feed at strict 3h intervals (eldest was so poorly and lifeless he would not have woken to feed) and I expressed milk and gave a top up of breast milk after every feed. Was tough for a week or two but he got better and remained EBF. He self-weaned at 14/15 months.

With my youngest, I was more open minded about using formal from the outset if needed. Eldest had really struggled to latch and feed, and I do think I could have avoided him becoming so ill if I had given him a bit of formula early on and not been so stubborn about breastfeeding that I essentially let him get to the point of being really sick. Fortunately, she fed very easily and, although still yellow, was well with it and never met criteria for treatment.

I had a bit of an argument with them when I had my last baby. He cried a lot and I was told he must be hungry give him formula, seems to be the first advice given rather than look for potential other causes. I expressed and showed the dam woman how much I was getting fed him expressed milk and only then she accepted he wasn't hungry. I'd been made to feel like a terrible mother for wanting to be sure formula was the only option. So while I can't comment on jaundice (my eldest was mildly jaundice but all they said was feed her as much as possible) I don't trust being told you have to formula feed when its the first thing said and the only thing considered

Thanks everyone!

I didn't give her formula, I made sure she was fed at least every 2 hours and I would wake her up properly before each feed.

We went back to hospital and her bilirubin levels went down! Still need one more check tomorrow and if it's down again, we will be discharged.

I'm not against formula, just not at this stage for us considering she was early and also she's eating so well there doesn't seem to be any need.

I supplemented with my youngest, many years ago. She had lost over 10% of her birth weight and was bordering on jaundice.

It took very little time of offering about two ounces of formula after feeds for her to regain the weight and have her blood work come back clear. She really only took the full two ounces at the end-of-afternoon feed when my supply was low.

Once she was back on track I took her off the formula and she kept going with BF.