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Hi
folks, have to wade in on this one.... :-)
Certainly much much less overt physiological jaundice in my private
practice.
One
theory/explanation about bilirubin in newborns that I've come across
is that bilirubin is an antioxident and mops up all the free radicals liberated
by the birthing process and if you do bilirubin levels on all babies, all of
them have some.
Overt
physiological jaundice and deepening of same is very much to do with inadequate
attachment/poor colostrum transfer and with homebirth/private
practice mother/baby dyads, early B/F with excellent attachment is the norm
as the mothers are very well prepared for the realities of what to do and how it
works....babies guts are well stimulated, meconium is passed easily and early;
the entire range of normal physiological processes and cellular interactions
with feeding are optimally initiated and maintained. Women understand
normal newborn behaviour/feeding patterns and feed their babies to rhythm rather
that reading their babies signals as unsettled or troublesome those first few
nights. All of which allows babies to adapt to extrauterine life and its
demands in the optimal way.
Note:
I'm not talking here about those factors such as blood incompatibilies,
bruising, prematurity, infection etc etc that impact upon the neonates
physiology. I'm talking about healthy term newborn babies.
As far
as over reacting to physiological jaundice - kernicterus is a worry with sick
and premature babies - the blood brain barrier is not robust in these
infants. For full term, healthy babies, there is greater tolerance - less
need to do those heel prick levels when the baby is active, alert and feeding
and the baby is slightly jaundiced - my criteria is the whites of eyes
being yellow (and there are shades of that aren't there?) - and the levels
are always lower than one thinks they would be. My criteria of light bath
is being near an open window, not sun and kept warm, out of breeze.
On home maternity visiting runs, making sure from day 0 the infant is
getting excellent/optimal transfer of milk/colostrum helps avoid much of these
concerns.
Can
anyone tell me what makes the UV from "lights" ok for babies skin
health?
warmly, Carolyn Hastie
I haven't heard this theory before, Denise, but
have to put on this post that I have noticed, as have homebirth colleagues of
mine, that there is a very low incidence of jaundice in infants born at home.
Between us we think the rare use of oxytocics, any medications in labour,
early and frequent feeding - there's probably more. Any other homebirth
midwives want to comment on this?
----- Original Message -----
Sent: Monday, July 14, 2003 5:24
AM
Subject: Re: [ozmidwifery] Sun
baths
Dear mary
Your comment
I also wonder if we haven't been seduced into being a bit paranoid
about jaundice?
Reminded me of hearing at a breastfeeding confernece here a few years
ago of preliminary studies being done in the States (USA) by (?) Prof
G (?) which was exploring the benefits of levels jaundice as it is
physiological to a degree and there is a theory that this may be of benefit
to the developing immune systems and many babies who have some physiological
jaundice have lower rates of infections in infancy and childhood.
Does any one else heard of this
theory??
Denise
----- Original Message -----
Sent: Saturday, July 12, 2003 4:11
AM
Subject: Re: [ozmidwifery] Sun
baths
Thanks for that information Lois, My understanding was that we needed
620 NM of light waves for effectiveness. Johnson says " exposing the
baby's skin to sunlight".. does this mean direct through the glass
or indirect through the glass or direct sunshine or indirect near the
window? As you say, it is very difficult to quantify the number of
nanometers in the various seasons in Australia. I also wonder if we
haven't been seduced into being a bit paranoid about jaundice? What
is the range of nanometers of the bililights that are currently used for
treatment? When I was researching it for my research proposal, the
research seemed to be going away from the causes of jaundice and the
simple solutions, into the area of drug control of SBRs. That area
doesn't seem to have taken off and I wonder what the latest research
says? MM
----- Original Message -----
Sent: Saturday, July 12, 2003 12:56
PM
Subject: Re: [ozmidwifery] Sun
baths
Hi again - interesting to get info related to
the northern hemisphere.. (thanks Debbie and Marilyn), compared to
Australia.
I revisited my text books before
posting my bit on ozmid about natural light for treating physiological
jaundice - just to check my facts. The use of natural light this
way is mentioned in PGB. Johnston's book "The Newborn Child" (my
text from my mid studies) pp181,and 187. Johnson states "exposing
the baby's skin to sunlight effectively reduces the bilirubin
level but is impractical for treatment in the UK."
Regarding the specific lighting requirement -
"exposing the skin to blue light of wavelength 400-500 nm and in an
intensity of 4-10 microwatts/cm2 converts the bilirubin in the
superficial capillaries to harmless water soluble metabolites which
are then excreted in the urine and bowel". I don't know how to
quantify/measure the nm's of natural daylight in various states or
seasons in Australia, however I don't think it's necessary.
The value of exposure to INDIRECT 'white' daylight in a well lit
room to convert unconjugated bilirubin into conjugated water
soluble bilirubin for excretion is well documented. Exposure of
the head and shoulders, maybe chest in a temperature-controlled
environment is usually sufficient to stimulate the process, in
combination with frequent feeding.
Home and hospital rooms vary in how much light
they get, but often it's only a matter of rearranging where the baby is
located in the room which makes the difference. I'm sure there are
hospital midwives out there who encourage women to put their baby's cot
on the opposite side of the bed just to take advantage of the natural
light in the room to minimise or treat physiological jaundice the
natural way, just as I did when I worked in the hospitals.
Attention to this type of early treatment will
save many babies from the heel pricks for SBR collections
('just to check'), and possibly from separation and Mothers' associated
anxiety, interuptions to feedings and so on related
to artificial phototherapy. Just my two bob's
worth! Cheers, Lois
----- Original Message -----
Sent: Saturday, July 12, 2003
2:37 PM
Subject: [ozmidwifery] Sun
baths
Lois wrote:
Hi Tina, my understanding
is that normal bright 'white' daylight in a well lit room is adequate
to facilitate the conversion of bilirubin in it's fat soluble form
stored in the tissue, to the water soluble form, which is then
returned to the bloodstream for processing through the GI system
for excretion.
I was always told just to put babies in a
well-lit room (and this was in the lukewarm sunlight of the northern
hemisphere - London to be exact).
This is just from a mother's
perspective.
Debbie
Slater
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