jaundice risk question, sibling factor?

[nfowife]

Both my older kids had jaundice that required phototherapy. DD had to be readmitted to the hospital at 4 days old for 2 nights (hers was a high of 25, she had a vacuum delivery with some bruising which I know conributed). DS had a high of 17 and we did home phototherapy for 2 nights, I think it was from days 4-6.
Anyhow, from what I'm reading this increases the risk for this baby to have jaundice. I'm wondering how early can they test bili levels? Can I request this immediately at birth, would it be too early to show up? I'm thinking if we are already going to be at the hospital and they have the lights there I may as well just see if they will do the phototherapy there but I'm not sure they will if the levels aren't high enough. I'd like to avoid home phototherapy and all the appointments for blood checks, etc. If I can. My regular ped does not have attending rights at the hospital where I will deliver so I will have to use the on-call ped there until I am discharged and can see my own pediatrician. I haven't had a chance to ask her this question as I haven't had to take my kids in to her recently!

[babyready]

Both of my kids had jaundice, we had to do lights with the younger one but not my oldest. I think with my oldest, she started showing some signs of jaundice before we left the hospital but her levels were not very high yet. They increased and then peaked a few days later. I'm pretty sure that is the norm.

We were out of the hospital just after 24 hours with my youngest and she did not have high bili levels at all at that point. Again, they checked them a few days later and she had to have lights at home.

I am pretty sure that this is the norm, that bili levels peak a few days after birth. I have no idea if doing lights earlier is an option. Natural light is supposed to help prevent levels from getting too high, so maybe lights would help if done early. I do not know.

Good luck!

[lowrioh]

I asked my Ped about this and he said that we should bring it up to the Ped on call when DD2 is born but that the bili levels often don't get high enough to warrant treatment until a few days after birth. I asked if they would put her under the lights prophylactically and he said probably not.
I am going to push for phototherapy at the first sign of high bili levels though.
DD1 was readmitted for jaundice a few days after birth and it was fairly miserable. I'll let you know what happens.

[swissair81]

The do a tcb (trans cutaneous bili) at 24 & 48 hours. If you have a history of other kids with it, they shouldn't discharge you early & should possibly keep you longer. They are at high risk of requiring phototherapy if they had a sibling with this issue, had jaundice at less than 24 hours of age, GA of less than 38 weeks at birth, feeding issues and others. There is a whole list. My dd3's bili was 18.5 & we also did phototherapy at home. TG for biliblankets. I was told that with my next baby, they will be super vigilant before they discharge us.

[newg]

both of mine had it. but both of mine were born early (34 and 36 weeks) and DD1 also had trouble nursing due to being tongue tied.
I had c-sections with both of them, so I stayed in the hospital long enough to have things taken care of. I did have to have one blood check with each of them. For DD2 a home nurse came to our house they day after we were discharged and checked her levels.....which was so much nicer than having to pack her up and find someone to take her blood (which we had to do with DD1).

[BigDog]

DS1 was born at 38 weeks and we had to do the light therapy at home. It wasn't enough and his bili level kept going up, so by day 5 or 6 he was admitted to the hospital with a bili level of 21. It sucked.
DS2 was born at 40weeks with no jaundice issues, thankfully.
I'm pretty sure bili levels peak around day 4, which is why they usually suggest that you take your newborn to your ped for a checkup within 5-7 days of being born.

[daisymommy]

I have never heard/read of any connection with siblings being at higher risk if one baby has jaundice. I just Googled it, multiple different ways, and came up with nothing like that. Has anyone else ever heard that before and I just haven't?

It has to do with your baby's liver not being able to process the excess bilirubin produced by his own liver. Seeing as how every baby's liver is different, I can't see how there would be any connection between siblings.

http://kidshealth.org/parent/pregnancy_center/newborn_care/jaundice.html

[lowrioh]

I have never heard/read of any connection with siblings being at higher risk if one baby has jaundice. I just Googled it, multiple different ways, and came up with nothing like that. Has anyone else ever heard that before and I just haven't?

It has to do with your baby's liver not being able to process the excess bilirubin produced by his own liver. Seeing as how every baby's liver is different, I can't see how there would be any connection between siblings.

http://kidshealth.org/parent/pregnancy_center/newborn_care/jaundice.html

I think it depends on the suspected cause of the excess billirubin. In my case I'm blood type O- and my DH is A+. DD1 was also A+ so we had ABO incompatibility which our doc suspected contributed to the jaundice.

[luckytwenty]

When it's a blood type issue, yes, there's going to be a higher risk for siblings. My two boys were Coombs positive because I'm O+ and they are A. DH is AB, and my daughter was B, and didn't have serious jaundice.

Both boys needed phototherapy and my 2 week old still has "residual jaundice" and unsatisfactory weight gain, so we now have to add 4 oz. of formula a night. (Which really sucks because I have to get up and pump during that feeding, as my milk supply at this point is very well-established. But I could go on...)

[swissair81]

I have never heard/read of any connection with siblings being at higher risk if one baby has jaundice. I just Googled it, multiple different ways, and came up with nothing like that. Has anyone else ever heard that before and I just haven't?


This was the first link I came up with: Risk Factors for Hyperbilirubinemia

Infants without identified risk factors rarely have total serum bilirubin levels above 12 mg per dL (205 μ mol per L). As the number of risk factors increases, the potential to develop markedly elevated bilirubin levels also increases.2

Common risk factors for hyperbilirubinemia include fetal-maternal blood group incompatibility, prematurity, and a previously affected sibling (Table 1).2–4 Cephalohematomas, bruising, and trauma from instrumented delivery may increase the risk for serum bilirubin elevation. Delayed meconium passage also increases the risk. Infants with risk factors should be monitored closely during the first days to weeks of life.

http://www.aafp.org/afp/2002/0215/p599.html

[swissair81]

TABLE 1
Risk Factors for Hyperbilirubinemia in Newborns

Maternal factors :
Blood type ABO or Rh incompatibility
Breastfeeding Drugs: diazepam (Valium), oxytocin (Pitocin)
Ethnicity: Asian, Native American
Maternal illness: gestational diabetes


Neonatal factors:
Birth trauma: cephalohematoma, cutaneous bruising, instrumented delivery
Drugs: sulfisoxazole acetyl with erythromycin ethylsuccinate (Pediazole), chloramphenicol (Chloromycetin)
Excessive weight loss after birth
Infections: TORCH
Infrequent feedings
Male gender
Polycythemia
Prematurity
Previous sibling with hyperbilirubinemia

(TORCH = toxoplasmosis, other viruses, rubella, cytomegalovirus, herpes (simplex) viruses.)

[swissair81]

I'm pretty sure bili levels peak around day 4, which is why they usually suggest that you take your newborn to your ped for a checkup within 5-7 days of being born.

See, they discharged us at about 48 hours. I had to be in the ped's office the next morning & I was in the hospital lab at least daily, sometimes twice. I would have preferred to stay a few more days. The first week was so traumatic.

[swissair81]

When it's a blood type issue, yes, there's going to be a higher risk for siblings. My two boys were Coombs positive because I'm O+ and they are A. DH is AB, and my daughter was B, and didn't have serious jaundice.

Both boys needed phototherapy and my 2 week old still has "residual jaundice" and unsatisfactory weight gain, so we now have to add 4 oz. of formula a night. (Which really sucks because I have to get up and pump during that feeding, as my milk supply at this point is very well-established. But I could go on...)

My issue was not ABO compatibility. It was starvation jaundice. You can't force a newborn to nurse, which made it very hard. I spent a lot of time syringe feeding my newborn.
Call a lactation consultant. I got very good advice after delivery, which did not include the formula that my ped suggested.

[daisymommy]

Wow. I had never read that before. Does the medical community know why it is a risk factor?
I don't mean if there is a blood incompatibility, that makes perfect sense. I mean in other cases.

[oneontheway]

I just went through this with DC#3. DC#2 had a severe case of jaundice due to blood type incompatability. DH is A and I'm O. DC#1 is O, DC #2 and #3 are A and both had pretty bad cases. I was told that they test the bili levels if they know the parents are different blood types. With DC#3 they caught it right away although he spend 2 days in double photo therapy and was sent home with the wallaby for 2 more days. I would just insist they test him right away if you and your husband's blood types are incompatible. Good luck :)

[willow33]

Just wanted to add my experience. All three of my children have O+ blood just like DH. I have O- blood type. Both my boys had to have phototherapy and DS1 stayed in the hospital for 2 extra days. When DD (3rd baby) was born I was very worried about jaundice. She never had any issues.

[HIU8]

DS was jaundice. He ended up spending 1 week under lights at home with visiting nurses taking blood (so we didn't have to go back and forth to the hospital). His levels kept going up and we came very close to have him admitted to the hospital. Thankfully they dropped back down after a week. DS was born at 38 weeks.

DD, also born at 38 weeks, was not jaundice at all.

[brgnmom]

Both my older kids had jaundice that required phototherapy. DD had to be readmitted to the hospital at 4 days old for 2 nights (hers was a high of 25, she had a vacuum delivery with some bruising which I know conributed). DS had a high of 17 and we did home phototherapy for 2 nights, I think it was from days 4-6.
Anyhow, from what I'm reading this increases the risk for this baby to have jaundice. I'm wondering how early can they test bili levels? Can I request this immediately at birth, would it be too early to show up? I'm thinking if we are already going to be at the hospital and they have the lights there I may as well just see if they will do the phototherapy there but I'm not sure they will if the levels aren't high enough. I'd like to avoid home phototherapy and all the appointments for blood checks, etc. If I can. My regular ped does not have attending rights at the hospital where I will deliver so I will have to use the on-call ped there until I am discharged and can see my own pediatrician. I haven't had a chance to ask her this question as I haven't had to take my kids in to her recently!

we had an early discharge with our second child who was born last Friday, and we were able to go home 24-hours after her birth. We needed to stay until DD received her newborn screen testing and PKU levels can only be accurately measured at/after the 24-hour mark. Right before we were discharged, DD's bili levels were measured which were within normal range at the hospital. 3 days after she was born, we saw her pediatrician for the first appointment and he thought we should re-test her bili levels. Her levels were 13.9 which was considered medium/high-risk for jaundice. DD's doctor told us that bili levels tend to naturally increase a couple of days after a baby's birth, but he suggested that I add supplementation before my breastmilk fully came in. Our first baby had no major risk factors for jaundice, so I think the pediatrician felt that the extra formula would help DD speed up the meconium output and reduce the bili levels that way. We followed his advice and supplemented on top of nursing, and when DD was 5 days old, her bili levels were re-tested and measured around 10 and she didn't have jaundice. no light therapy was required at the hospital, but we did take her outside and expose her to some natural sunlight indirectly which I think helped.

my DD was born at 40 weeks, although the chairperson for pediatrics who evaluated her at the hospital thinks that my DD was overdue & that my original due date (by LMP) in the end of October was more accurate based upon my DD's appearance. my firstborn (DS) was born at 40.5 weeks and he was not jaundiced at all.

[hillview]

Both boys had it. It doesn't seem to become something measurable/an issue until day 5+ so early testing doesn't seem predictive.
/hillary