hi all

I have read recently that babies of Asian and American Indian decent are
more prone to elevated serum Bilirubin Levels.  Does this mean that a baby
of Asian descent with a borderline SBL of  should routinely undergo
phototherapy or should other factors be taken into account such as
sleepiness, breastfeeding etc.

A bit of background to this question may help you make a little more sense
of it.

This baby's mum is Japanese.

The baby was born after being given oxycitocin to sped up the labour.
Pethidine given 1 hr before delivery.  Mother fed baby 1 hour after
delivery.  Had 500 ml postpartem bleed - Hb 8.4.  Baby very sleepy.  Feeds
very few and not attaching well, falling to sleep after a couple of sucks
and then not waking.  Various techniques attempted to wake baby.  Day 3
still very sleepy and showing urates.  Blood glucose low and baby gavaraged
with formula. (Yes we all would have prefered the mum expressed and probably
should have been expressing before this due to the sleepness to help
establish supply but the nurses on duty did not think about expressing the
colostrum a gavaraging with this.)  Baby was being taken to breast when
waking but was not able to attach or stay awake long enough to feed
adequately.  The baby was then gavarage another 3 times.  Day 4 baby feeds 2
times and discharged.  It had only 1 muceonium poo and not pooed in 24hr.
On day 5 the mum encouraged to take baby back to hospital  as bub has a weak
cry, still no further poos, 2 wet nappies in 24hrs, and sleeping 10 hrs.
Bub did a big poo (I was not given a description) and had feed from both
side and mum bega to drip milk from the other side.  Mum sent home again
only to be called in the next day so that phototherapy could begin for
jaundice.

Since readmission baby is breastfeeding 3rd hrly (midwives are happy with
this) while under phototherapy and are happy with the lactation side of
things.  Baby has since developed fever and investigations are underway to
discover why.

I suspect that there are lots of factors exacerbating the SBL - The lack of
colostrum breastmilk, the long period of time that it took for this little
one to expell the muceonium, the effect of the pethidine on suckling and
sleepiness as well as the forced and rapid bombshell entry into this world.

I am not a nurse or LC in this hospital.  The mum is very quite and does not
question much of what goes on and is not assertive in any way.  The partner
is struggling to deal with the issue of a sick baby and is concerned for mum
and baby and does not want to rock the boat. I am also finding it difficult
to communicate to the hospital staff that I am very concerned about the
health of the baby and breastmilk is the best food and fluid for a baby in
this situation and that the establishment of lactation is the only way that
this baby can recieve adequate breastmilk. (It all seems so simple and
commonsense to me.  I know that the staff is also concerned about the baby
and really we are on  the same side here and this post in no way questions
this nor is a put down to these people.  This post is just questioning it
all)

What I am hoping for is some ideas from everyone out there about how the
racial anomolies such as raised BSL in Asian babies when borderling should
be dealt with from a lactation point of view and also from the health risks
of the baby - after all the health of the baby is obviously just sooooo
important.


Ruth Fiedler
Breastfeeding Counsellor

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