Neonatal Jaundice

Almost all babies (and adults) have jaundice so it is really no cause for concern. The yellowness of the new born is the result of build up of bilirubin in the baby’s blood due to the immature development of their liver to clear off the waste material in the body. Most babies return to their normal pinkish self within the first week but for my last three babies, their yellowness stuck with them for at least a month which means constant blood tests and visits to the paediatrician.

It was no exception for Ephraim. In fact, his jaundice was probably the worst of them all. I have compiled my notes on his progress through his first month and hope that this sharing would be some source of information or comfort for mothers who have been diagnosed with breast milk jaundice like me. As the saying goes, ‘This too shall pass.”

Ephraim was discharged with a serum bilirubin (SB) count of 11.4 (184) which was higher than the ideal of less than 10. The consulting PD assigned randomly by the hospital had advised for him to stay a day longer in the hospital, and I was welcome to stay one more night with him. Based on my past experiences, I knew that this would be a long drawn battle with jaundice so I declined and had us both discharged.

Treatment #1 Home photo therapy

To placate the doctor’s concern, I agreed to home treatment and rented a Bilibed from the Baby Specialist for $370 for 3 days, 2 nights. Ephraim would have to stay on the bed naked except for his diapers throughout the day, and to be taken out only for feeds, diaper changes or baths. While I tried to follow the instructions to the letter, Ephraim struggled to stay in the Bilibed especially at night and I didn’t want to waste my sleeping time fighting him so I only left him on it during the day and took him out at night.

Three days later I went back to the PD to do another blood test. Ephraim’s SB level had risen to 15 and the PD once again insisted that I ward Ephraim. His concern was that if left unchecked, high SB levels could result in the staining of the brain yellow which could lead to some form of brain damage in the later years. Once again I resisted knowing full well that he was not treating the cause of the jaundice and highly suspected the effectiveness of the phototherapy. The consultation fees plus blood test was $120!!

Treatment #2 Sunlight

While the doctor relented, he told us to continue with the home treatment and requested for another blood test two days later. Unbeknownst to him, I had already returned the Bilibed so for the next couple of days, I had to wake early in the morning and bring Ephraim out to be sunned. There is no conclusive evidence that sunlight works to remove bilirubin in the body though. To eliminate it from the blood stream, blue light is most effective in doing so, and while sunlight has it, it makes up only a percentage of all the different range of lights.

To sun him effectively, he had to be fully naked. To do this, I had Ephraim in his pram, unbuttoned his shirt down to his diapers and then sunned him directly under the morning sun for about 30 minutes. I didn’t dare to do it longer for fear of him getting burnt. I had to sun myself at the same time too just to make sure it wasn’t too hot.

We went back for our third blood test when Ephraim was about a week old and his SB count had continued to rise to about 19 (314). The doc was more insistent now that he be warded for at least two nights, and the ward charges would total to the range of a thousand dollars which was really put-offish.

Treatment #3 Formula Feed

The other alternative I was given was to get Ephraim off my breast milk as it seemed that due to blood Rh incompatibility, my milk was causing the baby’s red blood cells to break down faster, releasing more bilirubin into his body (or something like that). I decided to opt for this path, it made more sense to me to eliminate root of problem rather than simply treat the symptoms, plus I just didn’t like the way the PD talked down to me. Yes, I am very stubborn.

Over the weekend, I went full force into formula feeding Ephraim which meant double work of having to pump my breast milk. I didn’t like this arrangement because it also meant that my milk production would be affected. But it was lesser of two evils. I also continued to sun him daily which meant more trips out and less rest for my recovering body. So much for confinement. However by the end of the National Day weekend, it was evident that I was losing this battle with jaundice. Ephraim was getting more and more yellow, which also resulted in his excessive sleepiness.

Treatment #4 First dose of phototherapy

On Monday when I brought him back to the PD, I was more or less resigned to ward him against my better judgement. True enough Ephraim’s SB increased to 21 (353), which is bordering on the danger threshold. Though secretly I thought I had done a pretty good job curbing the increase. Nonetheless it was too tiring for me to keep it going so Ephraim was put back in Mt A for 2 nights.

The PD had instructed that he be put under 4 blue lights while normal treatment was only two lights. (The bilibed I brought back home was only 1 light hence it wasn’t really very effective – what a waste of money.) The only source of comfort was that I could use my Medisave to offset the hospital bills so the out of pocket pinch was less painful.

Ephraim’s SB count dropped to 13 after the first night so I asked the PD if I could put him back on breast milk. He said ok so I passed my entire store of expressed milk to the hospital for them to feed him with it. After the second night, Ephraim’s SB count dropped further to 9 so he was ready for discharge. But he looked in a worse shape than when I left him there. Rashes had developed around his eyes and his temples were bulging from wearing the eye mask over a prolonged period of time. I was really upset to him in such a sad state.

PD told us to follow up with another blood test a couple of days later to ensure that his SB level stayed down. This time I decided to do it at the polyclinic as it was more convenient and I really didn’t want to see that PD anymore. In any case I thought my fight against jaundice was over. But I was far from wrong. Three days later we did another test on Ephraim and I was horrified to see that his SB count had risen back to 18 (323)! The doc at the polyclinic didn’t want to hear any of my explanation and just referred me back to the hospital for follow up treatment. Nice. The polyclinic fees in contrast was only $12!

Interestingly I was asked to participate in some medical research whilst at the polyclinic. They were researching into using some non intrusive appliance to test a baby’s SB levels instead of depending on blood samples so I agreed to take part. The nurse just have to lightly tap the instrument on the baby’s forehead and sternum to measure his SB level. I just hope that the use of such appliance would be implemented soon as it is really excruciating for both mother and child to have to take blood test after blood test especially for recurring jaundice conditions like mine.

Treatment #5 Second dose of phototherapy and a working liver (and stay off Chinese herbs)

I called back the PD and found out he was on leave. I had a mind to just forget about it and live with the jaundice, afterall it has to go down eventually just like his brothers and sister. But I had niggling doubts if there could be other causes than just my breast milk, so I decided to make another trip to Mt A the next day. As the incumbent PD was away, I got to meet another PD instead. I have to say we hit off well right from the start when he told me that I was right that admitting for another phototherapy treatment was not the solution and that further investigation was required.

So I agreed to do a full blood test on Ephraim to test his liver etc. which resulted in me having to endure his cries for 10 minutes as the nurses had to pull 4 mini tubes of blood out of him. Thank God the results came back all normal with only one glaring problem, his SB was now 23 (393) and in the danger level. By now we were sure that the problem with Ephraim (or rather me) was breast milk and I might have inadvertently caused the number to rise so rapidly due to some herbal drink (some concoction with gan cao) that I took excessively over the weekend. Darn it!

We had to bring the numbers down rapidly so I agreed, this time more willingly, to ward Ephraim again. He had to stay in for 3 nights and I didn’t bother to visit since he was not allowed to drink my breast milk at all. Three days later when I went back to pick him up, his SB level had dropped to 8 and he looked much better than his last admission. In fact he looked like he had grown a ton in that few days away from me. I was so happy to see him all chubby and rosy.

Treatment #6 Feeding enough and frequently

Back home, I was to stay away from breast feeding for another three days until the next blood test but in between I started to give him some breast milk especially for the night feeds as I was too tired to get up and make milk for him. Taking the cue from how the hospital treated the babies, I ensured that Ephraim was fed frequently on a strict (kinda) 3-hourly schedule on 90ml (this was how much Ephraim needed, could be different for a smaller baby) of milk, and that he had at least 4 – 5 wet diapers. The idea here is that by feeding enough and frequently, the baby’s body would work optimally to dispose the bilirubin out of the body.

The next blood test showed that while his SB had still risen to about 15 (217), which was expected, thankfully and more importantly, had not spiked to previous high levels. So the PD told me to repeat the blood test at the polyclinic a few days later, which I did. The results showed that the SB remained constant so for the first time, it had stopped rising without the aid of the lights.

The doctor at the polyclinic seemed more experienced and while I have to repeat the blood test again a week later, it was no longer a cause for concern. The doc explained that the baby’s blood-brain membrane is fully formed by his third or fourth week of age, so there is now low risk of him suffering from any brain damage. I was relieved to hear this so I guess my battle against jaundice is finally over. It would take time for baby Ephraim to regain his pinkish self but at least he is out of danger.