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new mother Wrote:

-------------------------------------------------------

> I had understood that the increased fluid from

> formula flushed the br out faster than

> breast-feeding would have done.



No

Apparently something in breastmilk increases the proportion of bilrubin on circulation in the blood, as a protection for the liver

Kings do seem hyper alert to jaundice. Both mine ended up having phototherapy - for what I imagine was actually normal physiological jaundice. Neither of them showed any other signs of problems such as being overly sleepy etc. They also put me under a lot of pressure to do formula top up feeds with baby no. 2 - on day one after a c section, so only colostrum milk at that point, but absolutely all he needed. It is very difficult to fight these sorts of interventions when the doctors talk in alarmist terms about what can happen if jaundice is left 'untreated'. So you can be informed, but I'm not sure how you go about questioning the paediatricians when they seem so set on particular courses of action.
Had one with physiological and one with blood group type jaundice. No. 1, jaundice set in about day 3, stayed at home breastfeeding. The other was jaundiced within 6-12 hours after birth. He was saved from brain damage by the quick thinking staff at Kings and was put on lights and a bottle (with my colostrum and any milk I could produce within the first 48 hrs of childbirth). I am extremely grateful for all the treatment and have no regrets of him being fed with a bottle for 4-5 days (mix of formula and whatever I could produce). Day 6 he came home and got back on to the breast as though he had never left. I would question anyone who gets so single minded about breast feeding that they may risk their child's health.

Good point EDmummy!

Be very careful of attributing neonatal jaundice to breastfeeding - always seek medical advice if you think your baby is jaundiced. It may be a sign of dehydration or more complex conditions and remember that untreated jaundice due to a condition (not jaundice from breastfeeding) may cause irreversible problems for the baby.

From our experience I can understand why they are quite risk averse with physiological jaundice. In our baby's case he developed normal jaundice on day 2 at home but on day 4 he got worse very quickly. On the home visit that day our midwife called the newborn unit at Kings and sent us up for a blood test. Even though he was still waking to feed and wasn't dehydrated his bilirubin levels were much higher than expected and above the treatment line for a full blood exchange. Within 15 mins of the test he was admitted to ICU but thankfully avoided the blood exchange as the lights and some blood products were sufficient to get him out of danger. It was a nervous wait for 4 days while they ruled out causes such as the blood group incompatibility, infection and liver disease. We're still not sure what the cause was, although there were risk factors present such as me having prolonged rupture of the membranes, him being a bit early (37weeks) and also a ventouse delivery (which we were told increases the risk of jaundice due to the extra red blood cells to break down from the blister on the baby's skull). He was also born during the snow so there was no sunlight to give him a hand!


Regarding feeding, our experience was that we were consistently advised that breast milk was the best thing to clear the jaundice. As soon as he was admitted they got me expressing every 3 hours and when he was out of danger the nurses got him out of the box for me to nervously try to feed. The nurses and BF counsellors were incredibly kind and supportive. Our little man's barbados tan hung around for more than a month and at all the check ups at Kings and with the midwives I was told to just keep breastfeeding him.

Seems it's difficult to know what type of jaundice it is and whether it is serious or not doesn't it? With both of mine it developed +24hours after birth and once under the lights the br level came down really quickly - both out again within 12-18 hrs. I suppose that's why I'm a bit cross - in that it probably was unnecessary in their cases and it caused upset and meant I had to give my new baby formula, which I really didn't want to do. But obviously yes the baby's health comes first and if the risks are that unpredictable then you have to be cautious. Baby 1 quite liked his little sunbed actually, but baby 2 hated it and pretty much screamed the entire time - had a sore throat afterwards!

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