27 December 2012

14 Days: Phototherapy (Aryeh)

For exactly fourteen days, I've been blessed with our second sweetie, Aryeh. I want to share his birth story, but first I think I'd like to start with today. I learned to never doubt what I believe in, especially when it comes to the health of my children.

 
Despite testing in normal range for bilirubin levels on his date of birth and his well-baby check two days later, Aryeh became increasingly jaundiced. I was concerned, did my research, and decided to wait until his two week check today to bring it up. I explained to his pediatrician that I felt he was rather jaundiced, but filled plenty of diapers and had normal awake time. The doctor agreed that he looked rather yellow but didn't think it was anything to worry about. Mind you, I hear horror stories about brain damage and the like, so I wanted to be extra cautious. We decided getting another bilirubin test done would be a good idea.
A couple hours later the pediatric called back saying Aryeh's bilirubin levels had gone from 8 to 18 and that it was most likely "breastmilk jaundice". What's that you ask? According to the Birth,
'Breast milk jaundice' is a term given to a common type of mild jaundice that becomes persistent, or prolonged, for up to 6 to 12 weeks after the baby is born. The baby appears slightly yellow, but is well and healthy. Breast milk jaundice does not require any treatment because the levels of bilirubin are very low.Breast milk jaundice only relates to babies being breastfed (not surprisingly!) and the exact causes are not clear, although up to 30% of breastfed babies can have breast milk jaundice to some degree. It is thought that it may occur due to a combination of factors including:
  • An enzyme that some mothers have in their breast milk that can increase the reabsorption of bilirubin from the baby's bowel motions.
  • The breast milk possibly inhibiting the efficient processing of bilirubin in the liver.
(Breast milk jaundice is unrelated to "breastfeeding jaundice" where the newborn doesn't nurse enough to clear out old, excess red blood cells and becomes lethargic and ill with poor weight gain.)

So the pediatrician recommended that we stop breastfeeding for two days to allow the bilirubin levels to drop while switching to formula during that time. After two days, we would come in for bilirubin labs and a check up to see how he fares and to confirm the diagnosis. I asked multiple times if there weren't other options available to us such as phototherapy. He reiterated no. I explained the importance of nursing to us, my concerns with him not eating well if placed on a formula diet (he hates bottles and pacifiers), etc. This approach he wanted to pursue was considered outdated by many resources and doctors who were of the mindset that one should never stop nursing for breastmilk jaundice but rather treat the jaundice with phototherapy and do tests that rule out other possible causes. Josh saw how upset I was (I walked in with tears in my eyes and smeared eyeliner... Yuck!) and really didn't want Aryeh to stop nursing either (we aren't much for formula unless there is no choice). He insisted I not give up, and that I asks why phototherapy wasn't an option and seek a second opinion. We did lots of research that all insisted there was never a reason for newborns with breastmilk jaundice to stop nursing.

By the end of the day, after being told by multiple doctors that formula was the only choice, the neonatologist told one of the doctors I spoke to that I should not stop breastfeeding but that his bilirubin levels weren't high enough to qualify for outpatient phototherapy. Then I received a phone call from a doctor who was originally adamant about the formula who said they just looked back over the chart and noticed for the first time that he was a 37 weeker and sought out the outpatient lights as his levels are more serious for one 37 weeks.

If I hadn't had sought a second opinion and been an advocate for my son, he wouldn't have received the treatment he needed. We feel pretty good about that.

 

1 comments:

  1. Good for your Lauren!! Sorry to hear it was so difficult to get any doctors to listen to you, but great that you finally got some to listen.
    What a cute little boy you have! May the phototherapy work!

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