Hi everyone! I don't post often, but today I have a puzzling case that I
need help with. I've searched the archives with no success. I was
contacted by phone today by a mom of a 6 week old boy (experienced
breastfeeding mother, third baby). This baby has breastfed well since
birth, great weight gain, active, alert, had an earlier problem with
jaundice at 1 week of age, (bilirubin of 18, pediatrician stopped
breastfeeding for 24 hours, supplemented with ABM and it dropped to 13).
Resumed breastfeeding without difficulty, but color has remained jaundiced.
Baby has had no other problems except infrequent stooling since 3 1/2 weeks
of age. Great weight gain, 6 - 8 soaking wet diapers daily. Yesterday, in
a routine office visit, the doctor decided to recheck the bili level as the
baby remains jaundiced, and the level was 15. There are no obvious
pathologic reasons for it to remain elevated.
Now, the doctor has told the mother to stop breastfeeding for 5 days,
supplement with ABM, and pump to maintain supply (I'm not familiar with this
physician or know if he is breastfeeding supportive or knowledgeable). The
mother is distraught, and when she was talking with me was breastfeeding.
She did supplement for several feedings yesterday, and one today, but has
decided to continue breastfeeding right now until she has evidence that she
must stop. She knows that she does not pump frequently enough and is sure
that she will really diminish her supply if she stops for 5 days. The
doctor also has her giving the baby pear juice and water to encourage more
frequent stools! He has told her that bilirubin is excreted in the stools
and she must make that baby stool more often. She is to start prune juice
tomorrow if no stools!
I have a bunch of questions! What is the normal bilirubin level of a 6 week
old infant! I know that bilirubin is excreted in the stools initially when
there is meconium, but is this still true at 6 weeks when the baby is having
nice soft yellow breastmilk stools? I know the baby only stools once a
week, but this is common in some breastfed babies. Is this level harmful?
Does phototherapy at this age help? Does the mother need to stop
breastfeeding, and if so, for how long?
My "gut feeling" is that this infant is fine, growing well, and would be
fine if the mom just keeps breastfeeding and eventually the bilirubin will
drop, but, I have no references to support this. I've searched the AAP site
and can find no references to jaundice at 6 weeks. I would love to give
this mom referenced information to take back to her physician, but can't
find anything! Help! This mom can't wait to hear more information about this.
Thanks in advance!
Wendy Krzanowski, RNC, IBCLC
Uniontown, PA
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