# When is jaundice a concern?



## Greaseball (Feb 1, 2002)

I hear so many things about jaundiced babies who have to stop nursing and have to spend time under those lights. When does it become a problem? Isn't jaundice normal for all babies?

DD was jaundiced a few days after birth, and then 3 or 4 days later was back to normal. No one suggested that I should quit nursing or bring her to the doctor.

So when is it a problem?


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## pamamidwife (May 7, 2003)

when the jaundice is accompanied by a sick baby - one that will not nurse or is lethargic.

a healthy yellow baby is just that - healthy.









normal breastfed jaundice appears around day three or so and usually clears up within a week. the baby continues to nurse and appear normal.

jaundice from blood incompatibilities or other problems appears later or right at birth and is severe (even the legs are yellow) with a sick baby.


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## OnTheFence (Feb 15, 2003)

Quote:

_Originally posted by pamamidwife_
*when the jaundice is accompanied by a sick baby - one that will not nurse or is lethargic.

a healthy yellow baby is just that - healthy.









normal breastfed jaundice appears around day three or so and usually clears up within a week. the baby continues to nurse and appear normal.

jaundice from blood incompatibilities or other problems appears later or right at birth and is severe (even the legs are yellow) with a sick baby.*
Pam is absolutely right. It really upsets me the way pediatricians scare women into formula feeding a healthy baby. This almost happened to my aunt.








My daughter had jaundice from blood imcompatibilities and I didnt even think it was that bad (21 I believe it was). I continued to nurse her and brought her home at a 12. The son we adopted came home at a 19. We just let him sun bathe and he turned out ok! When my aunts baby was a 19 they threatened a blood transfusion! They also gave the baby formula without permission!


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## Monkey (Jun 21, 2003)

you posted this!
my son was yellow, ok... at the third day of arival, his eyes looked grey the white part and i aske the nurse about jaunice well they took some blood and his levles were at 15? so the next day we went back, so dumd we had to go back for 3 days poor babe, I know, but at the 5 day the levels were at 27? I think what ever it was it was "concidered to be a risk in the peds book. now mind you this ped was a mother #%#$$%^$^%$ I hated him, we are new to the area and i wasnt able to get the recomeneded ped in bc my c sesction was not prepared so i had to DEAL with this on call guy and he told me i should stop bf and that it is worse to bf i new diffrenbt but on 5 th day i was concerend my babay was sleepy and i wanted to take him in for light therapy, now heres the bad part they scared me into IV and dr told me if i didnt iv him he would have to stay longer SO P0XXED about it so i requested a very experienced nurse since the nurses in the childrens area couldnt even figure out the light machine!
so i got a er one and she did a terrific job, i was able to nures will he was under the lights we would take him out and sadly my choice to stay with my 5 day old son over night and not sleep a wink was a shock to the whole floor!
so my son was on a iv for 24 hours and looked as thought he was going to blow up. and after 24 hours his leavles were at 9 im guessing it was a while ago and very upseting for me. then that morn the dr comes and says oh he is still on the iv? oh i told the nures that after the first bag to take him off!!%#%^#^#$^$#

i stoped all contact with him was was able to see my other ped who is a wonderful dr. so thats my story.


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## anothermama (Nov 11, 2003)

Agree with Pam...

I think it's one of those things that the medical establishment plants in your head to make you worry and second guess yourself.

My dd was VERY typical...at about 3 or 4 days bam she turned yellow....it peaked at about a week and then faded. After doing some reading I never even really thought to seek treatment for it. And I didn't and my kid was fine.







: Like Pam said, she never really had any other symptoms. My midwife said to just watch her for not peeing or fever or whatnot, which never came. She was totally normal, just a little yellow looking.


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## Peppermint (Feb 12, 2003)

My first son was pretty jaundice, his level was right at the cut off, one point higher would've required the bili blanket at home. My fabulous pediatrician called a couple of times a day ( and we did take him for daily heel pricks as he was lathargic) to see how he was nursing. She said nurse every second you can, keep him in the sunlight, and eventually advised me to stop my prescription pain meds (from c-section birth), as she thought they might be contributing to his sleepiness. As soon as I stopped the meds, he woke more, nursed more, and his levels went right down.

Jaundice can be very dangerous, but not without warning signs mentioned by previous posters.

I learned this time around that all babies have some degree of jaundice, and that the quicker your milk comes in and the more you nurse, the quicker it goes, and the less severe it is (unless it's blood incompatibility-that I am not sure on).


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## clewal (Nov 20, 2001)

My daughter had jaundice pretty bad. Her levels were at 24, I think and we had to put her under the bili blanket at home. When we left the hospital they were at 18, I think (it was over a year ago, so my memory is pretty sketchy). We had to have home health come in to check her levels because we were having problems with the lab when it came to checking her levels. She was only under the blanket for a weekend, putting her in the sun was not helping the jaundice clear up. She was lethargic, slept a lot, and didn't have any wet or dirty diapers.
The hospital did try to get us to supplement with formula. I had a student nurse my last day and she took out all the formula samples that came with that free diaper bad, and a nurse followed her in with a ton of formula to take home. My dr told me just to supplement with water, the formula would keep her full and mess with nursing. The water got her to pee and have dirty diapers. Usually she would get the dirty diapers when we were on the way to the dr or to the store.
It turns out that my husband had severe jaundice when he was a baby. We also found out that with his blood type, jaundice is quite common, and my kids inherited his blood type.


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## Monkey (Jun 21, 2003)

clewal,
what is the blood type?

mine is o+ and my 1 son is and my other son is a-

just wondering...


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## curlygrrl (Jan 22, 2004)

I would be very interested to know more about this. I've heard so many horror stories about women being threatened with tranfusions for their babies unless they give them formula. I just don't think that's right.

My experience was different. I had type O+ blood and my son had A-, I imagine that had a lot to do with his jaundice. From the very beginning he was sleepy and lethargic.

He was born in a freestanding birth center so when we left only 7 hours after he was born nursing was not established at all. We had lots of problems, mostly due to the sleepiness and also refusal to latch.

The midwives never checked his levels, they insisted he was fine and they had seen babies much more yellow than that. Eventually we got nursing going and after a few weeks of breastmilk and sunlight the jaundice faded.

I imagine if we would have been in a hospital, things would have gone much differently.

Tamara


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## Monkey (Jun 21, 2003)

i am the same. o+ and son a-.... im glad to hear your soin is doing well, and i would have to believe in another situation it would have been handled diffrently..


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## clewal (Nov 20, 2001)

Both my kids and husband are As. According to the nurses, jaundice is more common in As. My son was also jaundiced, but the hospital had me start him on formula as soon as the yellow started. I was also in the hospital longer w/ him because of a c/section.


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## Monkey (Jun 21, 2003)

hmmm... thanks for answering..


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## shelbean91 (May 11, 2002)

We had a very bad case, at 10 days, ds was admitted for lights and iv b/c he was very dehydrated. If I remember correctly, the high end of normal is 13 or 14, ds was at 23 or 24. He wasn't nursing, he was very lethargic, and time in the sun wasn't correcting the problem.

Dd also had jaundice, but we laid her in the sun, she was eating and not lethargic and we had no problems.


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## captain optimism (Jan 2, 2003)

My friends' baby had jaundice and they didn't want to treat it at all, and the baby became very ill. The jaundice was all over the baby's body (some say as long as it doesn't go below the navel, you don't have to treat it) and she became weak and lethargic. They wound up in the hospital for almost three weeks, supplementing the baby with formula through a naso-gastric tube and had to have several blood tests.

I don't think the jaundice caused the other problems. Jaundice is a symptom, not an illness. One thing that might cause jaundice is poor feeding--either your breastmilk coming in late or the baby not latching on well. (The baby's body needs fluids to clear the extra bilirubin from the blood.) My friends were reluctant to trust their pediatrician when she said that the jaundice should be checked with a blood test. She is a holistic doctor and I think if she said that the jaundice was serious enough to be checked, they should have checked it right away!

To me, it's key to have your own pediatrician lined up before you have a baby, and to ask questions about how they treat jaundice before you give birth! The pediatrician should be able to tell you under what extremely very very rare conditions she or he would recommend supplementing with artificial baby milk in cases of jaundice.


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## lilyka (Nov 20, 2001)

My oldest dd went under the lights when her blood work came back at 14 but she was 6 weeks early and it can be much more serious in preemies the earlier they are the more serious it is. She was under the lights for 2-3 days (so long ago). They never once said I needed to give her formula or an IV though. They did want me to limit nursing but she had tube in her nose and she was still having problems from being early that directly related to her feedings. When I had her out of the bed they just turned the lights on us and put a heating lamp on us. With a normal healthy newborn I don't think you would even have to worry about a heating lamp or you could just use the blankets.

#3 had the bili test without my consent







on day 4 (which is the peak day in a breastfed baby) and her levels came back at 14. They wanted to do more blood work (which I thought was very unnessecary since we had already been through a blood work niughtmare - she had been poked over 25 times by day 4, and the Dr. still hadn't seen her) so i did some research. Dr. Sears says 24 in a normal newborn is where to start being concerned and Dr. Jay Gordan said anytihng up to 34. I would probably go with Dr. sears since he is a nice middle ground. I am pretty conservative when it comes to my childrens health. At anyrate, definitely try the sun first and then the blankets. In normal newborn jaundice there is no reason to interupt nursing (it may be nessecary to look at managing it with a slight schedule to optimize rest and light time but certainly no need to stop it altogether or give formula or bottles) or be seperated from your baby. I suppose if your baby has been lathargic and is suffering from dehydration an IV would be nessecary but hopefully you would notice things were off before it got to that point.


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## Monkey (Jun 21, 2003)

yes i wish i never had the iv myself but its so terrible the feeling i got in that hospital, not to mention the fact i hadent slept in over 5 days i was so upset..

well, now ill be much more informed. thanks all for the helpful info!

my 1st was premie and he to was under the lights but thankfully he only stayed 1 extra day in the hospital.

i wish i would have known more what dr sears and jay had said.


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## starrynight (Jan 10, 2002)

Just thought I'd throw in my two cents, in case anyone ever has a situation like mine. My son, believe it or not, had jaundice for about 4 1/2 months. He had breastmilk jaundice, which is harmless (though it was scary for me!) At six weeks his bilirubin count was 13. He was never lethargic or anything like that. In fact he's always been very healthy and energetic.

At the time I was so freaked out about his jaundice lasting so long that I almost gave him formula to try and make it go away. Luckily we have an awesome pediatrician who told me to just keep nursing him and that he was fine. I'm glad I listened to her. (As I'm still nursing him now and he's nearly 3!) Some of the things I learned about jaundice were interesting. One of them is that bilirubin is actually an antioxidant and that babies with jaundice have lower infection rates.

I've never heard about type A blood having more jaundice, though I find that interesting. My son is A- (as am I and DH). I guess with breastmilk jaundice the tendency is that all your babies will have it. I'm pregnant with #2 so I'm preparing myself. Anyway, just wanted to mention this. At the time my son had his jaundice I had a hard time finding anyone who had experienced anything similiar.


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## cottonwood (Nov 20, 2001)

I have no idea of what the bilirubin levels of any of my children were -- they turned dark a few days after birth and it took a long time for their coloring to return to normal. But they all breastfed well, gained weight, and were the opposite of lethargic. And have had no health problems (aside from the occasional cold.)

But they *were* quite dark, so I'm assuming their bilirubin levels would have been quite high. (Is this reasonable to assume?) So what I am wondering is, can high bili levels occur independently of illness? Is it possible that a baby with a level of, say, 24 isn't sick? Is it just a cautionary thing to begin treatment at a certain level, in the absence of other symptoms of illness? Or is a high level necessarily indicative of a problem?

And why is it that light therapy works, if it is not the bilirubin in itself that is dangerous? Or is it? If a baby with high levels is not treated because there are no other symptoms of illness, is it possible that the baby will have been weakened/damaged in some way by lack of treatment, that will become apparent in later life?

Obviously I do not know a lot about this.







:


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## Fleurette (Feb 28, 2003)

All of my babies had to be put under the lights for jaundice. While jaundice can be very common among babies, the doctors were VERY concerned about mine because we have blood incompatibility (they're all A+ and I'm O+) which complicates things if they don't get the bilirubin numbers down or at least stable in the "normal" range. Off the top of my head, I can't remember why it's not good (with the blood incompatibility), but I was never told I couldn't nurse. I was told they needed to stay under the lights for as long as possible and to take them out only to nurse/change diapers and cuddle a little while.


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## Spark (Nov 21, 2001)

Just to add another story of jaundice. My son had breastmilk jaundice. His levels were high I can't remember the exact number, but in the 20's. He was pure yellow for weeks. Yellow, yellow. Everything on him was yellow, especially the whites of his eyes (if you could call them whites). But, he nursed like a champ, had all the pees and poops needed and was very alert. He was not at all a sleepy baby. We put him in the sunlight and loved him. I was glad my Ped knew enough not to tell me to wean because we had breastmilk jaundice.

FYI -- Breastmilk jaundice is not that common, but it looks really bad if it happens to your baby. Weaning is not needed. The baby gradually begins to digest your milk better and heals himself. No real treatment is needed other than to make sure they're not showing "danger signs."

Blueviolet -- sounds like your kids might have had breastmilk jaundice, too.


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## Lisalee2 (Dec 12, 2001)

Both my dd & ds had jaundice for a short period. I don't think it was more than 2 weeks. At first I noticed it in the whites of their eyes and at the midwife's checkup, she looked at the rest of their bodies. She said it was just a mild case because it didn't spread lower than their faces. She mentioned that once it hits their chest / legs it may be more serious.

Not too much help, but just wanted to share my jaundice tales!


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## Henry's_Mamma (Jan 23, 2004)

My ds had blood incompatibilty jaundice (I''m O+, he's B+). What happens w/ this type of jaundice is that sometime during pg or l&d, mom & baby's blood mix. If mom has O blood, her body produces antibodies to the A or B blood of her baby and then passes those antibodies to her child. The child's body responds by rapidly breaking down red blood cells until it can rid itself of the antibodies. The by-product of the red blood cell breakdown is bilirubin, and b/c the baby's liver is still kicking into gear, it can't handle the overload and jaundice appears. This type of jaundice can be very severe and can happen very rapidly (my ds was under the lights within 30 hours of his birth -- drs. were concerned b/c of the rapidity w/which his bilirubin levels were increasing). If allowed to progress, jaundice (_i.e._, high bilirubin levels) can cause brain damage, but it would have to get pretty bad. The other risk w/blood type incompatibility is anemia if too many red blood cells are broken down. Anemia is dangerous in a newborn (red blood cells carry oxygen and oxygen is very important to maintain bodily functions and temp.), and on occasion, blood transfusions are necessary.

My ds was very alert after birth. By the time he went under the lights he was lethargic and wouldn't eat/nurse (the change was dramatic). We had to strip him to his diaper to keep him awake to eat, and we only had 30 minutes in which to feed him, every 3 hours for almost 3 full days. He was quite sick.

The reason supplementation w/formula is often pushed (esp. if your milk hasn't come in -- mine didn't come in for 6 days despite trying to bf ds and pumping) is b/c dehydration is a common complication (those lights are hot & drying) and by getting food & fluids moving through baby's system, you help the liver to start working better and encourage a bowel movement & urination, which gets rid of a lot of the waste (bilirubin). It was more important to me to get my ds healthy and home than to worry about a few days of supplementation ... it did make a huge difference for my ds.

HTH!


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## Greaseball (Feb 1, 2002)

Good thing dh and I are both O+. Sounds like we don't have to worry about all this.


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## 3_opihi (Jan 10, 2003)

My sons had ABO incompatibility as well. They are also part asian and I have heard that jaundice is very common in newborn asian males.

First baby had really really bad jaundice. He was orange like a carrot. I believe his levels were something like 22. He went under the lights, but we thankfully got to use the home one. I believe its called a Wallaby. It was really great. He was under the light, but still co-slept and breastfed. I suppose I was lucky because nobody ever even metioned giving him formula. I also think his jaundice risk was greatly increased because we used pitocin. Everyone I have ever talked to that had pitocin in labor, has had a newborn with jaundice. In fact, I'm going to start a thread on that right now.

Second ds was pretty orange too. But he never got sleepy and was nursing fine. I never got his levels checked because I figured as long as he was getting lots of breastmilk he would be fine. Coincidentally, I was still nursing older ds, and I wonder if me already having milk in my breasts helped to flush his system.

Greaseball, I think your baby will probably be ok. If he/she does get jaundice and they want to put him/her under the lights, just make sure you get the Wallaby. It doesn't need to be in the hospital.


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## Melaniee (Apr 15, 2002)

Our ped did lights at 20 (unless a baby's numbers were ascending rapidly and were likely to exceed 20 if he waited another day). Ds got to 18 before my milk came in and they stabilized and decreasted.

I've seen opinions to the contrary and he felt the bili blanket was almost useless. Unfortunately Ds was born during an early-cold week and it was cloudy so we couldn't get him much time outdoors or by the window without clothing.

We have ABO incompatilibity (and pitocin...hmmm...thinking of that other thread). He was sleepy from the start (we were separated during that alert-after-birth time when BFing is recommended to start), so that was even harder. I had LATCh problems so the last thing I wanted to do was keep him at teh breast all day (OUCH OUCH OUCH), so my milk was slower to come in. I guess I'll know better next time, but his being separated was not exactly voluntary. The NICU team felt he wasn't breathing easily.


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## ManyPeoplesMama (Feb 24, 2004)

A lot of people I know ended up giving up nursing because of jaundice, but out of 7 babies, all of mine have had it and some were quite yellow. It never occurred to me to stop nursing them. Man, I am glad I stay away from doctors. They give bad advice.


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## Melaniee (Apr 15, 2002)

I must say that when we asked our ped (in desperation trying to avoid the lights), "Isn't there ANYTHING else we can do?" He said, "Well, there is one but you prob. wouldn't want to do it...give formula." Of course we didn't but he gained some respect for not even bringing it up until we begged.


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## tarahsolazy (Jan 26, 2004)

Jaundice is a little tough, because, like many eloquent posters have noted, it is very common, and is often harmless. I am a pediatrican, soon to be neonatologist, so I treat this all the time. The jaundice that occurs due to blood group incompatibilities is just as a PP said, mom gives baby antibodies that break down baby's blood cells, and jaundice occurs. This type usually happens sooner (like in the first 24-28hrs) than the physiologic kind (3-4 days). I agree that in general, a jaundiced 4 or 5 day old who is feeding well, peeing and pooping several times a day, is in no danger. However, a baby jaundiced in the first day or two, or who is jaundiced to the legs, or who is really sleepy, not feeding, peeing, pooping, etc, should probably be checked. The danger is rare, but its irreversible brain damage from bilirubin staining the brain tissue. Light therapy, and (rarely needed), exchange blood transfusions, can prevent that. However, there is no need to give formula during phototherapy, breast milk works just great, anything to get those little bowels working. At my hospital, we encourage nursing, or, if the baby is too sleepy or can't latch, we will offer tube feeds of mother's milk, if the parents prefer. Or gentle use of IVs, in the case of a truly dehydrated baby. A baby who has been jaundiced for more than a week or two, even if healthy, should also have some blood tests, because some liver diseases (biliary atresia, etc), can present this way, and early treatment is better. One of the best things these days are transcutaneous bilimeters, which can check the bili using light, without a heel poke. Hopefully, these will become the standard, they are pretty accurate. Hope not to offend with my post, just one poor doc's experience.


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## Melaniee (Apr 15, 2002)

I'm not offended, of course one problem is that a mother with a sleepy newborn who doesn't want to latch probably won't have any milk to give. I wonder if one pumps, how long it takes for milk to come in? I pumped a bit in the hospital, but that with Ds my milk still didn't come in for 4 (or was it 5) days.


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