I have been working with a mom of fraternal twin girls who were born at
36 wks gestation. Shortly after birth, mom moved up to my area. I saw
the babies for the first time on 1/18 at ~5.75 wks of age for weight gain
problem. Both girls exhibited very good suck on digital examination but
needed some adjustments at breast to increase their intake. Mom's milk
supply seemed adequate but possibly low at that time; in my office baby
#1 took 30ccs on mom's "empty" (had nursed before coming in) breast
while baby #2 took a whopping 98ccs (and promptly spit up for the first
time several times afterwards) on the "full" breast. Baby #2 was and
still is jaundiced, but pediatrician has not been concerned. Their
weights have gone as followed:
Baby #1-- 12/9 BW 5#5; 1/18- 5#12.4; 1/21- 5#13.7; 1/26- 6#5.5;
1/30- 6#9.7
Baby #2-- 12/9 BW 5#14; 1/18- 5#7.7; 1/21- 5#9.9; 1/26- 5#14.7;
1/30- 6#1.6.
We added formula supplementation on 1/21 for both girls after hindmilk
supplementation was not enough, then discontinued formula for baby #1 the
next visit as she was doing very well. Mom reports that she is feeding
babies at least 8 times in 24 hours, and if baby #2 is discontent, tops
off with formula. Since *both* babies have been spitting up after feeds,
she feels that they both have been filled up, but also notes that #2 does
not suck as strongly as #1, with a growing disparity.
Looking at all of this, I am wondering why baby #2 is still jaundiced.
She is alert and eating, though gaining more slowly. Given her growth
history, would it be reasonable for normal physiologic jaundice to
persist this long? I've also considered breastmilk jaundice, but then
wonder why it would occur with only one baby and not two, since the going
theory is that Bm jaundice occurs due to an unusual factor in some
mother's milk that slows down the processing of bilirubin. We do know
that the two older siblings also had jaundice as babies, but mom does not
remember for how long. However, twin #1 has not been jaundiced at all.
What is going on here? Should I be concerned?
I've tried to get mom to log feeds and supplements, but with two other
youngsters at home and without the support of friends due to moving, she
just has not been able to keep it up enough for me to get an adequate
picture. Mom is very loving and very strongly desirous of breastfeeding,
and is the first mother of twins I've ever had show up at my door without
assistance and with both babies clutched against her chest snugly- no
plastic baby carriers! She is so obviously attached and bonded to these
babies and is a joy to watch. I am about ready to send her back to the
pediatrician for a work-up if #2's weight and color don't improve at our
next visit this week. Comments?
Lisa Marasco, BA, IBCLC
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