stories of ABO incompatibility and jaundice in newborn?

[american_mama]

This is not the way I wanted to introduce my daughter to the board, but I have a somewhat urgent question since we are seeing the doctor later today. My daughter was born a week ago, healthy and full term, but diagnosed with jaundice and ABO incompatibility on her third day. Can anyone else share their knowledge or experience with this (not ordinary jaundice, but jaundice complicated by ABO incompatibility)? What treatment was your child given and how soon did it work? Once the bilirubin went down, did your child have any further problems with anemia or anything else? Were you advised at any point to suspend breastfeeding, even temporarily?

For those who are curious, ABO incompatibility is when some of baby's blood gets into mom's system during labor, thus producing antibodies that pass back to baby and attack baby's own red blood cells, thinking they are foreign. It is not uncommon anf very treatable.

As treatment, my daughter was given intense light therapy and two rounds of IV immunoglobulins, PLUS I was told to suspend breastfeeding for 24 hours. I did, although I didn't really understand why, and pumped instead. Her bilirubin went down each day of the treatment (from 15.3 mg/dL to 11.x to 10.0), but then rose again after treatment stopped (too 11.9). We are going to the hospital today to see if it dropped or rose again. She is sleepier than she was before, and I, normally not a worrywart, am quite concerned that she'll have to be hospitalized again for another round of treatment.

[searchdog]

This is I believe what my DD had. She spent every moment in the nursery except to breastfeed basically the whole time we were in the hospital under the lights. We got to go home just after her 48 blood tests and her pediatrician told us just to watch her. She seemed ok but I think it was the next day or maybe the day after she looked REALLY yellow again so we had to take her back to the hospital for another blood test. They did it STAT so we got the results pretty quick the doctor said her bilirubin was going back down but that she had not peeked before we left the hospital so that is why she looked so yellow again. I did not have to give her any formula at that point (we have had to supplement since then) but her Dr said that would help reduce the jaundice, but he also said as long as i kept her under the lights all the time except to bf he was ok with not giving her formula. To answer you question we have not had any problems since. We have a very happy and healthy 5 month old who is very curious about everything.

ETA: They also said that if the Dr wanted apparently this is some sort of Bilirubin blanket you can take home to keep DC under lights, but at home. Someone else may know more about this.

[Rachels]

We went through that, too. I immediately did a TON of research, because Abigail ultimately wound up with a breastmilk jaundice that lasted through her first month. Here are the short facts: a bili level of less than 20 is not scary. Home treatment with lighhts is available for newborns. Lingering breastmilk jaundice is a normal occurrence and does not require treatment. If your daughter is Coombs negative (ask about this), the jaundice will resolve much more easily. And there is virtually never a medical indication to suspend breastfeeding, certainly not at levels like you're describing. My ped didn't know a lot of this stuff, and we ultimately switched peds over this issue. It was stressful at the time but ultimately a strong act of advocacy for my daughter.

Here is a link to an article that helped me decide what to do (Jack Newman is an MD and major breastfeeding researcher):

http://www.bflrc.com/newman/breastfeeding/jaundice.htm

And a few more-- you'll note that I'm posting stuff from people who really know about nursing, because the stuff from people who don't is inaccurate when it comes to nursing advice:

http://www.askdrsears.com/html/2/t029600.asp
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297
http://www.breastfeeding-basics.com/html/jaundice.shtml
http://www.kellymom.com/newman/illness_mother_baby_01-03.html

A statement from the AAP:
"The AAP discourages the interruption of breastfeeding in healthy term newborns and encourages continued and frequent breastfeeding (at least eight to ten times every 24 hours)." ...from the section "Treatment of Jaundice Associated With Breastfeeding in the Healthy Term Newborn"

Hang in there! I know it's a hard way to start with a new baby. This will pass and you guys will be just fine. PM me if you'd like my phone number for some extra support.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[bluej]

Alex had this. She stayed in the hospital for seven days. I was allowed to stay with her b/c I was breastfeeding. No one ever suggested that I should stop breastfeeding (my LC and nurse were very active in my care and they didn't want anything to interfere with the breastfeeding that we had FINALLY become successful at). It appeared that Alex's levels were going down so we were released and had to come back everyday for blood withdrawel for testing. On day two of that her bilirubin was on the rise so they had lights delivered to our home. That was not fun, but it was better than going back to the hospital. She was under the lights for four more days before her bilirubin was at a normal rate. She's now 11 and she has never had any problems with anemia.

I hope you find out good news at the Doctor today. It's not a fun way to start out one's life and I know it's very stressful for you. Congratulations on the birth of your daughter and I can't wait to hear more about her.

[C99]

To be honest, I don't know if this is what Nate had, but he did have severe jaundice as a newborn and it was complicated by the fact that my son was born 5 weeks premature, only weighed 5-12 at birth, and had a different blood type than mine. (There are so many things about my birth experience and Nate's first few days of life that are really fuzzy to me because no one ever explained in layman's terms what everything meant.) My son was in the NICU for 8 days, on the extra-strength UV lights for 2 days and on bililights for the next 5. He was released at 8 days old after being off the lights for 24 hours -- and his bili count also went up after coming off the lights. The neonatalogists said that was normal. I really never got to establish BFing in the hospital anyway, so I just kept pumping. My mom actually did a bunch of research that suggested that BFing was better than formula for preemies and high counts, so we advocated for that in the hospital whenever possible.

I'm sorry that my experience is not more clear. And I know it's a scary, scary time when something like this happens. I still feel like the doctors were trying to scare me into doing things that made their lives easier. Anyway, the upshot is that my son is a happy, healthy 21-month-old who breastfed successfully for 20 months. The biggest problem we've encountered is low iron and that's easily treatable. He was yellow for about 3 months after birth, but he's a good creamy color now. ;-) HTH

[american_mama]

Just an update.. everything is going well with my daughter and she doesn't need further treatment. We have a follow up appointment in 4 weeks and the most likely three outcomes are: 1) she's fine or 2) she's mildly anemic and needs iron drops or 3) she's severly anemic and has ongoing problems and needs a major blood transfusion. I strongly suspect she'll be fine.

In case anyone reads this inthe future and wants more info., I don't think light therapy at home (with a bili blanket or special home incubator) exists where I gave birth. Also, I did find one source on the internet that said recent studies have shown good success with IV immunoglobulins, so I feel that course of treatment had some basis behind it. As for temporarily stopping breastfeeding, this sounds like bad advice at the worst and debatable advice at the best, but I can live with it. My DD does not have nipple confusion and my motivation and ability to breastfeed were not compromised, so everything has turned out OK.

As an aside, I do occasionally remember an article by a lactation consultant entitled "But just one bottle won't hurt... will it?" Her comments that indeed one bottle changed your baby's gut Ph and other things does sometimes make me feel bad. It's a good reminder to temper pro-breastfeeding advice and info. with some compassion for moms who find themselves in unexpected situations.

[Rachels]

I'm so glad she's doing okay! I do remember that article, and it's of course compelling. But you have to remember the other stuff that's out there, too, about the miracle of breastmilk and its ability over time to fix stuff that isn't going well. Yes, formula can change the gut pH, but exclusive breastfeeding is going to far, far outweigh any effects of that brief supplementation, and it's going to take good care of her, intestinally and otherwise. You're doing a good job, and you have been all along.

Keep in mind with ABO incompatibility that mild, lingering jaundice sometimes happens. We went through that-- our daughter's level at three weeks old was 14.2. That's breastmilk jaundice and doesn't require treatment. It might be worth reading up on that so that you're prepared to talk things over with your physician if your baby winds up in that boat. As for anemia, Abigail never had any, and as you know the iron in breastmilk is almost completely absorbed, so continuing to nurse her now helps ward off that possibility.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[starrynight]

I'm glad she is doing better already!! Some sunlight is good too, if it's cold where you are but at least the sun is out you could sit her next to the window and let the sunlight shine on her.

[C99]

I'm glad that everything is going well!

>As an aside, I do occasionally remember an article by a
>lactation consultant entitled "But just one bottle won't
>hurt... will it?" Her comments that indeed one bottle changed
>your baby's gut Ph and other things does sometimes make me
>feel bad. It's a good reminder to temper pro-breastfeeding
>advice and info. with some compassion for moms who find
>themselves in unexpected situations.

I know. I think my experience is what has made me less extremist about it. I've heard people say that facts and information should not make you feel guilty, but that piece of information makes me feel guilty about circumstances that really were out of my control every time I think about the article and what happened.

[Rachels]

I've thought a lot about this. There's a difference between feelign regretful and feelign guilty. If I'd had to formula feed Abigail, I'd be sad about it and I'd continue to wish it hadn't happened. But for a circumstance completely out of my control, I wouldn't feel guilty in the sense of feeling responsible. There are reasons for just about every intervention we've come up with. Most of them are far too overused, but that doesn't mean there's never any legitimate reason to use them at all. Formula is one. If you take action to keep your child healthy, you're doing a good thing. Please be gentle with yourselves.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[Melanie]

Keep nursing! Absolutely do not stop breastfeeding! I simply cannot believe that they told you such a thing!!

My son had the same problem (I am O+ he is B+). We did not do any treatments as we were lucky and the day my milk came in (probably the last day we had before treatment started) his bilirubin level plateaued, and then began to plummet. Your baby needs your milk!

I am so sorry...that must be very scarey for you guys...she must have had a really high level to require such an aggressive treatment. I hope she is better, soon.

You can help by exposing as much of her skin as possible to sunlight...if it is too cold to be outside with bare skin, put her by a window. The sunlight, as well as her body digesting your milk (okay, to be honest...anything...even formula...but your milk is better!) and emitting waste will help.

Being sleepy is a sign of the jaundice. I remember how terribly hard it was to wake Ds to nurse in those first couple of weeks. He wasn't great at it, so my milk didn't come in for about 4 days.

ETA: DUH! It's an old thread...sorry I missed it the first time around. I'm glad she is doing better. I'm also regretful over the early bottles of formula Ds had (not b/c of jaundice b/c of BF problems...we got into a nasty circle with those), but I could only do what I knew...and I didn't know what I know now. You just have to move on. You'll know more next time and even more after that and so on! I, of course, am nervous given that all of my children will have this ABO compatilibility, but I'll work smarter with the BFing from the start next time.

[Kieransmom]

Kieran had this and he was on 2 Biliblankets for about a week at home. They also have another name...something to do with a kangaroo. Whatever, anyway, it was a real pain but it worked. We had a home health nurse visit daily. I know they made me supplement him with fomula but I still breastfed. I wish I could remember why they would say not to b-feed. They were pushing that on me too.
I hope all is better. Keep your chin up!

Michelle
Mommy to Kieran, born 5/9/03

http://lilypie.com/baby2/030509/1/5/0/+10/.png[/img][/url]

[Rachels]

Melanie, unless your DH has type AB blood, what you're describing isn't ABO incompatibility. The jaundice in ABO babies is a result of the parents' incompatible bloodtypes, not the bloodtype differences between mother and baby. There's certainly reason to be hopeful that you won't have to endure jaundice with your next baby.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[octmom]

Karen,

Congratulations!!! I was thinking about you just a few days ago and wondering if there was any news yet. I'm sorry that you have had to deal with so much already, but it sounds as if it is all working out.

Take good care of both of you!

Jerilyn
DS, Sean 10/03

"Baby makes days shorter, nights longer, home happier, and love stronger."

[Melanie]

Rachel, he does. I know they aren't foolproof, but any blood-type predictors I've ever used have my child as being A or B which, in my understanding, is going to cause this problem again. I just hope, we'll be as lucky and it won't need aggressive treatment. Ds only got to 18...but it sure didn't help BFing!

Can you explain a little more what you mean about it's the incompatibility between the parents and not the mother and the baby? I'd been told it was b/c I was O+ and Ds is B+...(though, for frame of reference Dh is AB+).

[american_mama]

I was told that the key element is whether your blood and your baby's mixes during labor. This is no problem if you are the same blood type, but may be a problem if you are different blood types. There is no way to predict or prevent whether mixing of blood will happen or not, but I don't believe it will happen in every birth. I may also have been told that some babies do not react negatively even if the two blood types do mix, just like one child may have allergies but his sibling not.

Whether my info. here is correct or not, I can say with certainty that my older daughter experienced only normal, mild jaundice after her birth which required no treatment, no blood draw, and no diagnosis of ABO incompatibility. So I am almost positive that it is not automatic that another child will have it.

[Melanie]

I wonder how my blood would mix into the baby's during childbirth?

AND, I wonder if delaying of the cord-cutting would help or hinder this?

Oh Rachel....? ;)

[Rachels]

Okay, let me see if I remember all this well enough to explain it more clearly. The problem with ABO incompatibility really does stem from the mother's and father's bloodtypes being incompatible, but the reason they're incompatible is because they're likely to produce a bloodtype in the baby that argues with the mother's. If a type O mother has a baby with A, B, or AB blood AND a positive Coombs test, the baby is likely to have jaundice or anemia that requires treatment. The Coombs test looks for antibodies to the red blood cells. Sometimes the antibodies are attached to the red blood cells, and sometimes they're sort of freely circulating. In any case, they can aggravate jaundice and anemia. From what I read, if the baby has type B blood, especially, there's more of a risk of jaundice.

If the mother and father are ABO incompatible but the baby has a negative Coombs test, the jaundice will almost certainly resolve very easily. Babies with positive Coombs tests have higher likelihoods of needing blood transfusions. Having ABO incompatibility does not guarantee a positive Coombs; we had it and Abby was Coombs negative. For future reference, if you know you are facing ABO incompatibility possibilities, you can check the baby's bloodtype and Coombs status by sampling the cord blood at birth. Type-and-Coombs tests require a lot of blood, and it's certainly a lot more painful and invasive to do it via heel stick than via cord blood sampling.

As for delayed cord clamping, the jury seems to still be out on that. Babies are exposed to more of their mothers' blood if clamping of the cord is delayed, and for an ABO incompatibilty problem, there's certainly the chance that that could aggravate things. There are also resources out there that say it doesn't, though. I think you have to choose your battles. The primary advantage of delayed clamping is that the baby is still being supplied with oxygen via the umbilical cord. This is really helpful and important for slow-to-start babies. If you cut the cord and the baby doesn't breathe right away, you've got a bigger problem requiring more intrusive intervention. I had a nearly 38-hour posterior labor, and Abigail was exhausted at birth and didn't breathe right away. In her case, nobody panicked because nobody had cut the cord. As long as it was still pulsing, she was getting oxygen, so we could work on getting her going without having to subject her to intubation. If I had a baby that yelled out right away next time, I might choose to cut the cord faster to lessen the ABO problems. I'd err on the side of delaying, though.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[Rachels]

Oh, yeah, forgot to respond to that part. The PP is correct-- having ABO setups does not mean you will have a jaundiced child. The Coombs test can tell you a lot more about that. I posted about that below.

As for the blood types mixing during labor, that's not quite accurate. The baby is exposed to the mother's blood via the umbilical cord, and that happens regardless. The problem is if the bloodtypes are incompatible in such a way that the baby is going to develop antibodies to its own red blood cells. There's no way to prevent the baby from coming into contact with the mother's blood-- it happens throughout pregnancy and childbirth. But this is a place where delayed cord clamping may possibly have an effect. See my other post for more on that. :)


-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!

[Melanie]

Thank you so much Rachel! Ds did have his cord blood kept and tested...the Coombs test must be what they did b/c I recall the first night being told something about him having a 'sensitivity' or higher likelihood of jaundice.

Those heel tests are wretched, but that's another story!

Ds was slow to start, sort of. He did cry right away, but they cut his cord and whisked him to be roughed up and deep suctioned. =( Then he was having trouble breathing (in their opinion b/c his nostrils were flaring). Luckily an hour of oxygen and all was well. IMHO, it was probably due to all the invasive drugs, etc. during labor. Not in our birth plan, but of course it could have been worse.

Thanks again...

Melanie

[Rachels]

One more clarification, just having gone back and reread what I wrote. The antibodies which are found in the bloodstreams of Coombs-positive babies actually originate with the mother. The mother forms antibodies to the baby's bloodtype, which is for her protection, but then those antibodies cross the placenta and wind up in the baby's bloodstream, where they attack the baby's own red blood cells. In really severe cases, the baby may require a very significant blood transfusion to clean things up.

-Rachel
Mom to Abigail Rose
5/18/02


"When you know better, you do better."
Maya Angelou

http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Two years and counting!