Re: Jaundice and meconium; Minimum service levels
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.
Re: Jaundice and meconium
Dear Kirsten: I am with you in that the jaundice by 24hrs seems a little early to be blaming it on unpassed mec. I have seen p(a)eds here (USA, Seattle and one in California) give suppositories to babies who are a little lethargic and yellow on days 4 or 5, however the first 24 hrs is a different story. But it couldn't be ABO or Rh incompatibility: you ruled that out. marilyn -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: Jaundice and meconium
Maybe the problem is in the phrase looking jaundiced. Its not a very scientific basis on which to diagnose a pathological problem. Don't know about the meconium 's effect at such an early time. I await further input. Cheers, MM -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: Jaundice and meconium
Kirsten, Quickly and off the top of my head Bilirubin is reabsorbed from the bowel raising bilirubin levels in the foetus but is cleared from the system by the placenta and the developing foetal liver etc. After birth the placenta is lost to the neonate making it solely responsible for its own clearance of bilirubin. The sooner mec is passed then this source of reabsorption is lost and this is one very important reason why early breastfeeding is so important. Can bilirubin levels rise enough from this source alone to make the baby jaundice in the first 24 hours? Possible but less likely than other reasons such as ABO which is more usual in the first 24 hours. Good source of info Blackburn Loper (1992) Maternal. Fetal neonata Physiology: A clinical perspective, Saunders Andrea Quanchi -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: Jaundice and meconium
Dear Kirsten I am going to give my nod to the OB nurses in this case. If I saw a baby at 24 hours, who has not yet passed decent amounts of meconium, I would be asking why. Particularly if jaundice is present. There may be other causes, such as Abo or another blood incompatibility factor, but mec can contribute. I would not use a thermometer or suppository, but I would massage around the baby's anus with my finger and some gentle oil. By holding bub's legs up against his abdo, you can assist the baby's efforts to push it out. If this doesn't work you have to wonder if there could be an obstruction, and watch for meconium ileus. (Animal mothers are often observed to lick their baby's bottoms, and encourage bowel actions that way.) Early suckling gives the baby colostrum which has a laxative effect. Babies who don't get the colostrum early in their lives may become jaundiced for no other reason than delayed meconium passage. Best wishes from another aussie who spent a considerable time in USA with a green card, and experienced maternity services as a consumer. Joy Johnston -Original Message- From: Kirsten Blacker [SMTP:[EMAIL PROTECTED]] Sent: Monday, March 11, 2002 4:11 AM To: [EMAIL PROTECTED] Subject:Jaundice and meconium HI all, A question for the more phyisiologically minded amongst us. I was caring for a mother-baby the other day. At about 24 hours of age the baby already was looking jaundiced, and had not pooped. The OB nurses I work with seem to think that BECAUSE the baby had not yet passed mec, that was why he was looking jaundiced, which just didn't sit right with me, particularly at 24 hours of age. So they stimulated the rectum with a thermometer, and got a nice cot full of the best black stuff, which made them happy. They told mum t hen that everything should be fine because the baby had pooped now. I reinforced to mum frequent breastfeeding, and also quickly reviewed blood group for ABO incompatability (mum was B+). ANYWAY, my question is, particularly at such an early age was the connection reasonable? The theory seemed to be that the bilirubin was being reabsorbed from the gut and causing jaundice, which doesn't sound 'right' to me. Thoughts, oh wise ones? Kirsten Blacker infliciting her crazy Australian ways on the unsuspecting American public in Minnesota, USA. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
