Monday, 28 July 2008
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Phototherapy: Best Treatment for Jaundice?
by Mama KoalaAfter posting my story about the first week of breastfeeding, I had to write down my thoughts on phototherapy treatment (or light treatment) for newborns with jaundice. I know that some doctors recommend it if the bilirubin level is close to 20, and I think that's wise if the jaundice started at birth and has nothing to do with breastfeeding. However, after doing some research, it seems pretty common for breastfed babies who are fine at birth to develop a higher bilirubin level during the first week of life... and maybe it's not that dangerous, unless the level is higher than 25, as in Baby Koala's case. (I'm no expert, so please take what I say with a grain of salt.)
Baby Koala in what I call the phototherapy "tank"When she was just 5 days old, Baby Koala went back to the hospital for 2 nights/3 days of phototherapy. When Baby Koala came home after treatment, she did not cry AT ALL the first day. A newborn barely a week old... without the strength or will to make noise because she had worn out her vocal chords from crying too much at the hospital. And even after that day, her cries were hoarse for a few more days. Yes it could've been a lot worse, and I am very thankful for the doctors who discovered the problem and treated it right away. But still, it broke my heart to see her that way.
I hope to never put another baby of mine through that ordeal a few days after entering the world. When a friend recently called to ask me if she should leave her daughter at the hospital with a bilirubin level of 18, I told her to do what she felt was right, but that if it was my baby I would bundle her up, take her home, and put her in the sunlight while trying to get her to feed as often as possible. She listened to my advice, and told me later that the pediatrician got mad at her for not following her instructions (she ended up switching doctors after that
). Oh well. Her baby is healthy, and currently thriving on mommy's milk, and my friend is glad that she did not have to put her daughter through unnecessary stress. Of course, this is just one case, and I certainly don't mean for everyone to ignore their doctor's advice!If you were my friend, what would you have done? Have you ever gone against a recommendation given by your doctor or pediatrician?
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Comments (18)
Our pediatrician is our family doctor whom I have a good relationship with. She is awesome, and I know I'm blessed to have her! She will give her professional advice, sometimes more strongly than others, but she always respects that it is my body, or the body of my children and I have to make a decision for myself. I have never been one to listen to everything a doctor (or anyone else says). I am a firm believer in a woman's intuition and there are just some things that you'll always know better than anyone else.
As for the photo therapy, I had heard that most breastfed babies are prone to higher bilirubin levels, so when both of my babies were born, I let them lay on our couch which is right below a window in the mornings and afternoons to get additional light. The both loved the warmth and seemed to sleep better there anyway!! I always recommend this to my friends who are breastfeeding.
Douglas was slightly jaundiced a couple of days after his birth. His levels were never tested because we had a midwife and everything was done at home. If you pressed on him, it would remain yellow, and the whites of his eyes were slightly yellow. I just breastfed him consistently and it cleared up within a day.
When Newbaby went in for his one week, they did a heel stick and discovered his bili level was 19. Since it was higher than when he left the hospital, and doctors in general don't like it to hit 20, this drew some concern from the pediatrician. He called us in for a consult and explained the options. We could 1) put him in the sunlight for about a half hour per day over the next week, make sure he eats at least once every three hours, and get a re-check at 2 weeks- he didn't seem to like this option, 2) Switch Newbaby to formula-only until jaundice went away completely, 3) "wait and see," with the distinct possibility of phototherapy or other hospitalisation at the end of that.
We chose the sunlight route. By his next checkup, Newbaby was a pasty white baby, and had gained weight. They did another level, and called us in for another consult. Turns out his level had only dropped a few points, and although he wasn't at risk for anything, the doctor wanted to let us know his diagnosis. Basically, there are some breastfeeding mothers who have a protein in their milk that sustains jaundice- this means it does not raise it, but it doesn't allow it to lower either- and the doctor thought Newmommy was one of these women. Naturally, this made her feel like it was her fault, and being only 2 weeks removed from a birth( a C-section, at that), she was a little emotional. He recommended "for her sake" that we switch to formula until his five week checkup. His five week is today, and Newbaby has never even seen formula, let alone had it for dinner. We think breastfeeding our child is worth him having a bit of a yellow tint.
Oh I remember that times. My daughter bilirubin was high level 18 but was not require to go to phototherapy treatment. I just swaddle her and put her in the sunlight and she's fine.
It all depends, doctors should know best, but not all do. Sometimes the best advice can be from a friend or a new mom who has already gone thru it. If you dont want to see your baby suffer(who does?) why let them go thru that?
I will write a blog on this. This is not entirely correct information! There is a difference between physiologic and pathologic jaundice of newborns. There is not concrete bilirubin levels that require phototherapy...it is based on how many hours old the newborn is. Also, it depends on risk factors of the newborn such as blood type incompatibilites of the mother and baby. I will explain all of this. Please know that NOT treating your jaundice baby can be VERY dangerous. I will elaborate. This concerns me very much when people are doing their own internet research and do not have all the information they need to make appropriate decisions. While I appreciate informed people who have the capability to ask educated questions and encourage people to ask for a second opinion if they feel their provider is not giving adequate explanations, it is not in your child's best interests to plan their treatments.
Luckily D was really easy-going with the whole light treatment. He was so knocked out by the jaudice that he slept the entire time he was under the light. I worried about him screaming and me just having to sit and watch, but he did great. There were a couple times he cried, but I'd offer my finger to suck on and that would soothe him. It sounds like you and your little guy were not quite so lucky.
I've heard that some hospitals will let you take the light home and give the treatment there instead of at the hospital.
It's hard knowing what to do, but with something like jaundice the treatment is pretty much 100% effective, and seems to work pretty quickly, and letting the jaundice go untreated can be very very bad. I would probably follow whatever my doctor were to advise were my next baby to need light therapy.
D was able to go home after spending 3 nights in the hospital ( he was under the light for about 36 hours, then stayed another 24+ for monitoring to make sure bilirubin levels were stable). He still stayed kinda yellow for another month or 2 after that, but it was at a safe level.
@NurseJenna - thanks so much for offering to blog on this! this is a topic that's really hard to research on the Internet because of all the differing views and the medical terminology used (sometimes a small word makes a huge difference!). if it's possible, i'd appreciate it so much if you could give us more information about the types of jaundice commonly associated with breastfeeding. thanks again =)
@newdaddy - oh, i love how your doctor explained the various options at the beginning. even after the phototherapy treatment, my daughter still had bili levels higher than 15 for weeks because of breastfeeding. i didn't give her formula either, and i'm so glad that i stuck with breastfeeding. she only got sick once in her first year of life, and she hasn't had any ear infections yet (i don't know if there's a direction connection, but those are pretty decent stats!).
@mamawhale - @Kates533@xanga - that's great that your babies just needed sunlight . i'm going to do that if i breastfeed any future children. my mistake was keeping my baby away from the windows because people told me that the draft was too strong (january 2007 was incredibly cold!!).
@mamahippo - sigh yes, i bet if baby koala didn't have such a terrible time during the phototherapy or needle pricking, i would think it was the best method. also, i wonder if being a first-time mom has something to do with how emotional i got seeing her so worn out and sad.
I got scolded in the hospital for my daughter's jaundice and told to feed her more often, every two hours, three at most. The nursing staff made it seem like a really big deal and it kind of stressed me wondering if she was getting enough, peeing enough, etc. When the pediatrician came in to talk to us before taking her home, we asked her about it because I was really concerned! She did tell us it was quite common and that she was doing fine and to just keep nursing her a lot and it should clear up on its own, which it did. I do tend to listen to doctors but I also do a lot of reading on my own, book and internet, so that and have some idea of what they are talking about, what is common treatment, etc, so that if something doesn't sound right, I can further question them about it.
I went against my doctor's advice when Little Bit was born too. She was also a jaundice baby. I researched it, and decided that I was taking my baby home with me. LB was born in June so we spent a lot of times out doors in the sunshine and I breastfed her as often as she would eat. She thrived. I switched doctors as well. I didn't like being presented with only one option.
I think as long as you keep your baby monitored because you never know. I stayed at the hospital with my baby. She was admitted a few days after she was born and we had gone home. I was told she might have to have a blood transfusion because the billirubin level was so high. That was the scariest thing that has ever happened. Thankfully she was better and then I took her home. She never cried, she always has been quite quiet and peacefull. I did allow her a dummy because it gave her comfort and also used the finger trick a lot. I was also able to breastfeed her and even though she and i stayed there during new years I still feel that was the best thing for her.
My son was diagnosed with jaundice within 24 hours of birth with a level of 20. He was placed under lights for almost 36 hours. He was so mad!!! I wasn't aware I had the option at that time to just do sunlight. I was so exhausted from a long labor and an emotional wreak from hearing that he had to be put under the light. I guess it was fine, but I do blame (sorta) the time he was under the light for my inability to get him to breastfeed and finally my low milk supply. I felt rushed whenever I tried to breastfeed him during that time since the nurses wanted to keep his time out of the light to a minimum. So I would only try to bf for a minute before we would give him supplement formula.
I heared about jaundice in new born baby tonight. I got to the hospital where my wife and 2day old baby were on admission after a cs operations. i was surprised and somewhat scared when i saw my daughter under a phototherapy light and had to do some research on it. This is my second child and the first experience.My wife has never breast feeded before because the milk wont come out. What gives me consolation about the whole thing is that it is harmless if properly treated with phototherapy.
My son was a little jaundiced about 36hrs old (like 11) and his ped. MADE me stay with him under the lights. It could have been because I had Jay at an Army hospital though. The dr said if it didn't get lower I was going to have to give Jay formula... NOPE. I fed him every 2 hours and let him eat for 30 minutes then back into the lights. Luckily he was able to stay in my room. He HATED the lights. Next baby will not get under them unless it is dangerously high!
Hello, I'm a paediatrician from UK, and found this site because I am currently writing a presentation on jaundice for teaching junior doctors. As a breed, paediatricians, at least in the UK, tend to be very anti-interventionalist if we can possibly help it - we don't like treating anybody unnecessarily. However, with jaundice, we admit we end up treating many babies who would have got better on their own. That's because we have no crystal ball to deduce which babies will develop complications. The complication we try to avoid in jaundice is called kernicterus. This is brain damage caused by toxicity of bilirubin, the pigment which turns babies yellow. It used to kill or cause brain damage in many children before we had effective treatments. Untreated, jaundiced babies may develop learning difficulties, cerebral palsy and deafness, and as I said, it can be fatal. Under-hydrated babies are also more prone to get jaundice, and severe under-hydration can cause strokes. The good news is, this condition is totally treatable! No baby need develop complications if they are carefully managed. The usual treatment, the phototherapy lamps, are not at all uncomfortable for the baby - it's like sunbathing, with none of the risks! Babies may appear to become more fractious - that's because jaundice is sedating, and they start to wake up and act more like normal noisy babies as they get better! Bit disappointing for Mum though, who is itching to get her baby home, and can interpret this new crying as her baby being distressed by the phototherapy.
Sunlight can help, but isn't a great way of managing jaundice. It only works on naked skin - in cold climates, your baby will freeze, in hot climates, you can be exposing them to the risks of sunburn and skin cancer, especially in white babies with their paler skin.
So, in summary, please please listen to your doctors in this instance - it's possible they may be being overcautious, but do you really want to take the risk that your baby will be the occasional one who is permanently damaged? However, if you do find yourself in this situation, please don't worry - they will get better with treatment, and treated babies don't have longlasting problems.
I have no agenda for saying this - I don't get paid by the ammount of investigations I do and the number of babies I treat - I'm just in it for helping kids!
Hope this helps. Congratulations, and enjoy your babies!
Naomi T, soon to be a Mum