breast milk jaundice.......any experience please.......need help quick for my friend.

[mytetherisending]

My friend has a son aged 2 wks, was jaundice but had phototherapy. They are in Cyprus in a military hospital and are telling her she has to stop bf for 48hrs for them to do tests. She is worried about her supply because she feeds about 10 times per day. Any perspective welcome. I also found a link which said it wasn't necessary.

DS developed 'breastmilk jaundice' when he was a few days old. He did lose quite a lot of weight and so we were hospitalised, he had phototherapy and I bf him loads, as well as the MWs topping him up with little cup feeds of EBM. We were discharged when he was 10 days old with instructions to keep bf and to wake for feeds if he went over 3 hours.

After a while he managed to wake himself up no probs! The jaundice took a good 6 weeks to clear completely, we had blood tests and paed checks in this time but at NO point did anyone suggest stopping bf.

10 times a day sounds pretty normal for a newborn, can be even more. How is the baby, weeing, pooing etc, alert periods?

The advice is bollocks. Breastmilk is best thing for babies with or without jaundice.

sorry I meant she is worried about her supply if she needs to stop for 48hrs, I know 10 times is normal and have said try to fit more in if she can.

What the baby needs is to be fed - do they possibly mean that they want her to express for 48 hours so that they can check that the baby is getting enough milk ? Literature suggests that stopping is def not the correct thing, and that bm jaundice sorts itself out over a few weeks.

If she doesn't want to challenge them on this, then if she expresses at least every 3 hours day and night while not feeding directly her supply should be OK - she'd also be best asking them to cup feed the baby so that he doesn't get used to bottle feeding in that time

This link might help www.cks.library.nhs.uk/patient_information_leaflet/jaundice_newborn.

I believe it would be more common to perform a split serum bilirubin test and urine analysis to give an indication of potential liver disease. Without knowing how her baby is and which tests they've had it is impossible to say how justified her doctors are in suggesting breastmilk jaundice, especially as the link suggests this test if levels rise after 6-7 days.

Just found this www.breastfeeding.co.uk/index.php?option=com_content&task=view&id=13&Itemid=38 and this www.childliverdisease.org/uploaded/File/Yellow%20Alert%20Jaundice%20Protocol%20March%202005.pdf.

Hope it's helpful

Hi -

My DS also has breastmilk jaundice and he is 11 weeks old. It is gradually wearing off but he had blood tests (took about 10 mins to undertake) at hospital at around 4 weeks to confirm it wasn't the serious kind of jaundice (very rare). He has not had any other kind of treatment or tests for it and at no point was I told that I would have to stop breast feeding. The consultant basically told me that they don't know why the condition occurs and to carry on bfing as normal and keep an eye on his general health, ie feeding, sleeping, and nappy contents etc.

One thing I will add that since the jaundice has started to wear off his weight gain has really improved having been quite a slow starter. Don't know for sure if the two are linked but may be useful to know.

Hope this helps.

thank you all for your info and experiences, its been a great help. The difficulty is that there are 2 obs and gynea drs at the hospital but other than getting second opinions from local hospitals (worse) she feels obliged to do as they say iyswim. I will send this thread.

Must be difficult for her being out in Cyprus, unfamiliar systems etc.

Would agree if she really feels pressured into stopping for 48 hrs, then expressing every 3 hrs (including through the night) will help keep supply up. Feel for her, must be v stressful.

Is this her 1st baby? Only ask because the bm supply is more delicate if you've not fed for years before.

I'd definitely ask for a 2nd opinion, even if it's just the other doctor. Also ask the MW's. She also needs to clarify exactly what they mean, and ask them to write down for her what tests they want to do.

Is an O&G doc the best person to be advising on this? Do they not have any paed docs out there? If not, then they can consult some in the UK if they are worried. I'd think needing to stop bfing a 2 wk old baby for 2 days (how are they proposing to feed him in that time?) is something they should only be doing under quite serious circumstances.

for your friend.

Hi, there is a local peadiatrician- Dr Eliades. He is quite good, however, due to there being no HV in Akrotiri the obs and gynea Consultants usually have sole care until the 6wk check. I need to check which Dr her ds is under. I know the system inside out because I used to work at the hospital on adult and peads, but didn't come across much jaundice tbh. I need to go and ask lots of questions.

yes it is her first baby.

The HV in Ay Nik was helpful when I spoke to her (this is going back 2 years now). Have the MW's said anything?

i am the friend in question and our doctor is Dr Eliades. we had our first HV today and then went to the hospital for the 2 week check with Dr Eliades. the MW took some blood and we talked about what was going to be done and they said no breastfeeding for 48hrs.

We got home and baby slept til about half 5 just as the MW rang with his test results. the Bilirubin levels had in fact dropped so we asked the question ' do we still need to give him formula instead of the breast?' Dr said yes but didn't give any sort of reason.

After a few phone calls between dad and midwife, dad finally spoke to the Dr who said either stop breastfeeding or i will refer you to Nicosia for further tests (which include more blood, urine tests and possibly a lumbar puncture) to which dad said 'hell no'.

I have continued to breast feed any further advice would be much appreciated.

My DS had jaundice and phototherapy. I was strongly advised to use formula for the 48 hours he was under the lamp because it made life easier for the medical professionals. I certainly didn't hear a medical argument for it, it was simply about the amount of milk consumed by him.

I pumped and pumped and managed to maintain my supply to the extent I am still breastfeeding him 2 years later. With the MW support I also tried to breastfeed him during the formula feeds although this had to be quick to get him back under the lamp. I was lucky though I think with my feeding.

Not sure what breastmilk jaundice is and if it is different from what DS says, but she will need to be strong if she really, really wants to breastfeed rather than ff. I lost the argument as I was weak from a post c-section infection.

2 of mine had phototherappy - ds1 really really severe and prolonged

she absolutely does not need to stop breast feeding - she needs to feed every 2 hours includuing during the night

oh yes both had tons of blood tests
ds3;'s has just cl;eared upp at 5 weeks ds1 took longer

Chris I would definately print out the links and perhaps phone one of the hospitals mentioned here www.childliverdisease.org/uploaded/File/Yellow%20Alert%20Jaundice%20Protocol%20March%202005.p df
If they say it isn't necessary to stop then ask Dr Eliades to phone them.
I would be inclined to let them do further tests in Nicosia as it is unlikely they will do a lumber pucture, scare tactics . They can't do it without your consent anyway. Ask for both the bilirubin test results, if split bilirubin is less than 20% of the total it is not likely to be serious.
Print out all the links we have given and take them to Eliades.

even when ds1 was really bad and it wasnt shifting and they condsidered a boold transfusion and calling in the regional liver speccialist and had every possible test., i was never ever told to stop breastfeeding

lunacy

I found one reference advocating stopping bfing here

In infants with breast milk jaundice, interruption of breastfeeding for 24-48 hours and feeding with breast milk substitutes often helps to reduce the bilirubin level. Evidence suggests that the simple expedient of supplementing feeds of breast milk with 5 mL of a breast milk substitute reduces the level and duration of jaundice in breast milk?fed infants.

So perhaps just giving 5ml of formula with each bf might help? Has your DS taken a bottle? I'd try cupfeeding, or even spoon feeding such a small quantity.

Remember to keep him out in the sunshine if possible (presuming you've still got some out there )

How has your baby's weight changed since birth?

oh yes, I was advised to keep DS in the sun. Was rather difficult in November but you ought to find that easier in Cyprus!

Actually it tips it down most days in Ctprus from Nov to Feb- their winter LOL

ds1 was over 400 at 2 days old and ds3 was over 300 at 5 days old....