----- Original Message -----
Sent: Sunday, July 13, 2003 4:01 AM
Subject: RE: [ozmidwifery] Sun
baths
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
