Yes I agree Leigh, it is the jaundice in the first 24 hrs that is concerning with this baby and hopefully the concern with meconium passage was not a red herring. It does seems that the obvious potential causes of hemolysis in the baby (and hence, jaundice): Rh factor and ABO incompatibility were ruled out by the mother's blood group and type: B+. There could be several other syndromes involved all of which are quite rare (Gilbert's syndrome comes to mind, never seen it just read about it, in relation to early jaundice). However, it seems that starting simple and as gentle as possible can be a good thing (removing the mec), while keeping a careful eye on the baby. Was there any reason for the baby to have experience bruising or hemmorhage? Kirsten, was this the end of the story? Was the delayed passage of mec in the first day responsibel for the jaundice? And while I know any jaundice in the first 24 hrs is a concern, how extensive was it? The only baby I personally have seen who had some jaundice on the first day which increased over the next week was with a mom who developed fulminating HELLP syndrome in labor (we had transfered to the hospital for failure to progress at 3-4 cm but no concerning BP's). On arrival at the hospital her BP was more elevated than it had been but still less than 140/90. When it didn't dip after she had an epidural the OB ordered PIH labs (actually apologizing for being conservative and CYA). She was as surprised as all of us when they can back elevated. Here we use mag sulfate for preventing seizures, so our poor mom had to put up with the side effects during pushing (she went to complete in 2 hours after getting the epidural). She birthed her lovely 8 lb baby in about 45 minutes. There was heavy mec at birth and baby did need some resusc. but was really quite fine (Apgars 7/9). The hospital staff were fastidious about checking the baby for jaundice and when he did yellow up on the first day checked his bilirubin levels, they were not at a level requiring therapy but they were high and went higher. The parents actually refused phototherapy, and the baby did recover after losing weight down to 7lb in the first week, and causing us all some concern (they discharged on day 2, we visited on day 3 and called in the pediatrician to assess the baby, bili levels were high and borderline (sorry I can't remember the numbers or the units)) but the parents were convinced all would be ok, and it was, once the milk really came in, but he was always pooping (right from birth) and peeing and nursing around the clock. Long story.
I searched the net for associations of newborn jaundice and HELLP syndrome, and all I found was an association, but no explanation. I am assuming that one of the enzymes that causes hemolysis in the mum can cross the placenta and cause hemolysis in the baby, but I am making that up. Does anyone know or does no one know? Associating jaundice with the baby of a mom with fulmimating HELLP seemed to be tacit knowledge on the postnatal ward at the hospital, but maybe they check bili levels on all their babies (I am sure they check on all those jaundiced in the first 24 hrs). This mom too had no blood incaompatibility problem she is A+. marilyn -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
