Adventures in the NICU: Jaundice
No parent ever wants to see their baby in the NICU. Ever. No matter the circumstances. However, it’s a reality many of us face.
When my son was born, I’ll admit, I didn’t know that I was supposed to wake him up to nurse every two to three hours for the first couple of weeks. When he was three days old, he took a four and a half hour nap and I thought it was pretty cool. I had always been told, “never wake a sleeping baby.”
I know this isn’t necessary with ALL babies, but TJ had some risk factors for jaundice that we weren’t aware of that meant I should have been nursing him around the clock. No one said anything at the hospital, we simply didn’t know.
He was a very sleepy baby as a newborn, often falling asleep at the breast after just a few minutes. At five or six days old, my husband and I noticed his skin was looking a little orange.
When he was seven days old, he had his first visit with our pediatrician. He had gained a few ounces past his birth weight, so he was apparently getting enough to eat, despite his terrible latch. They pricked his heel to test his bilirubin levels.
In newborns, elevated bilirubin is normal as their red blood cells (hemoglobin) convert from fetal hemoglobin (super oxygen rich) to adult hemoglobin. In the womb, the placenta flushes bilirubin from their body. Once the baby is born, the liver takes over. Normally, their little body flushes out the bilirubin over the course of a few days to a couple of weeks. For premature and even some full-term babies, their liver hasn’t developed enough to be able to flush out the excess bilirubin.
These babies are diagnosed with jaundice and present with symptoms of yellowing of the skin and whites of the eyes and sleepiness. Most of the time, jaundice is relatively harmless, but if it goes untreated, extremely high bilirubin levels can cause brain damage.
At seven days old, TJ’s bilirubin level was 19, and our pediatrician considered it high enough to warrant some phototherapy. The body absorbs blue light through the skin and it helps break down the bilirubin into a form that’s easier to pass out of the body.
Our pediatrician prescribed a “bili-blanket” for us to use at home. It’s basically two flat paddles that have a blue light inside. We were supposed to lay one paddle along TJ’s bare back and one along his chest and then swaddle him. Considering that he hated being swaddled, it was quite a challenge.
After two sleepless nights with the bili-blanket, his level was checked again: 21. With the level rising, our pediatrician recommended that he spend a couple of nights in the NICU getting a more thorough dose of phototherapy.
Apparently, babies who are born a little early tend to get jaundiced easier, since their livers are still developing. TJ was born naturally at 37 weeks. According to the doctor, babies who are of asian or hispanic descent tend to get jaundice easier than other demographics (TJ’s daddy is Chinese). Plus we have some family history with jaundice; when I was a newborn, my parents had to bring me back to the hospital because of jaundice too. Babies who are jaundiced are also very sleepy babies, and often fall asleep when nursing, something we were definitely dealing with.
So with heavy hearts, we took our son back to the hospital where he was born.
It was agony for me… seeing my son crying in the isolette and me, not allowed to hold him. The nurses were wonderful, but I was asked to leave the room when they started his IV. The neonatologist wanted him to get IV fluids since he still had a bad latch when breastfeeding.
Since his visit, I have heard of nurses adjusting the lights so a new mama can hold her baby skin-to-skin and breastfeed while still giving phototherapy to the baby. No one ever suggested this option for me. If they had, I would have done it in a heartbeat, even if that meant I spent the night in the NICU.
Once his IV was started and we had all of the paperwork squared away, it was time to feed him, but I wasn’t allowed to nurse him.
Our pediatrician said that he needed to be given formula for the first twelve hours to help flush out the excess bilirubin. He explained that since breast milk is so easy to digest, it takes longer for the bilirubin to leave his body. Formula is harder for his newborn body to digest, so it supposedly takes more bilirubin with it.
At the time, that explanation made total sense to me. I was tremendously hormonal and I had no reason to question it.
I have since learned that this wasn’t necessary and that breast milk would have done just fine.
I tried, but I couldn’t feed my own son. I had to feed him in the isolette; I couldn’t actually hold him. He didn’t like the taste of the formula. He was also smelling his mama but sucking on an artificial nipple, something that was foreign to him. So, of course, he fought me. My breasts were literally throbbing in pain at his cries. I gave up almost instantly and asked the nurse to feed him. I know she was being gentle, but through the tears in my eyes and the hormones in my head, it looked to me like she was shoving the bottle down his tiny throat.
I tried so hard not to fall apart in the NICU. When I looked around, I saw many babies who were much sicker than mine. Silent tears streamed down my face, but I managed to hold it together pretty well until we left the hospital that night.
Because I couldn’t feed my son, my husband and I felt it was best to simply go home for the night. Then I melted down in the car. All I could think about was if he started to cry, they wouldn’t hold him; they would leave him to cry. I later learned that wasn’t the case, but it didn’t help me that first night.
My alarm was set to go off every three hours that night so I could pump, but I barely slept.
In the morning, his bilirubin level had dropped to 16; low enough that the neonatologist gave us the OK to resume breastfeeding.
We got there at 9 a.m. and I nursed him immediately and then again three hours later. The milk I had pumped the night before was enough to get him through the rest of the day. I was lucky that my body was responding well to pumping.
Then we came back that night, bringing more pumped milk. I nursed him at 9 p.m. and again at midnight. We repeated that cycle for three nights before his bilirubin level was low enough to finally go home. I was able to pump enough milk that he never got another drop of formula.
One benefit of our experience in the NICU was the tremendous help we received from the lactation consultant who was on-call those few days.
She helped us fix my son’s shallow latch and she gave my husband wonderful advice on how to support me though the rocky beginnings with breastfeeding.
A lot of lessons were learned for any future babies we may have since they will have many of the risk factors for jaundice.