Jaundice continues to be a real challenge.  I have had several in
the last couple weeks.  To me the biggest challenge is what I call
the "Catch-22" of jaundice.  Baby needs to eat more (especially with
physiologic jaundice), but the jaundice and to some extent the
treatment makes baby drowsy so he doesn't eat as well which
increases the jaundice so baby is even less interested in eating!
Sometimes you just have to get whatever you can into the baby by
whatever means you can to break that cycle.  Then you can focus on
optimizing the breastfeeding.
Bili lights are always a challenge with breastfeeding because of the
concern about baby not being away from the lights, and hence the
treatment, for very long periods.  In addition, the need to keep
baby's eyes covered while under the lights is an additional
stressor.  The bili bed is an improvement in that the "blindfold"
isn't required.  What works the best for continued nursing and
bonding is the bili "blanket" that can wrap around baby (often
referred to as Wallaby, which I think is one brand of it).  Saw a
mom just yesterday with this device.  She could get baby latched,
then dad would put the blanket against baby's back covering as much
skin as possible without interfering with the latch.  Now, even if
baby takes a long time to eat, the treatment is continuing.  We
sometimes have numbers so high that baby gets it from all sides
(lights from 2 directions and the blanket).  With the blanket, baby
at least gets some of the Rx when out from under the lights.
One frustration that peds have voiced to us is that insurance
mandates that baby is to be hospitalized if the number is over 20
(sorry, don't know how that converts to the European number) and
usually insists on home treatment if it is under 20.  So a baby with
a count of 17, for example, has to be treated at home unless and
until it reaches 21 even if the ped feels the numbers are rising
fast or baby is at other risk.  On the other hand, a baby with a 21
and mom's milk has just "come in" and/or baby has now learned to
nurse effectrively has to be hospitalized for Rx even though all
evidence is that those numbers are on the verge of dropping and baby
is showing no ill effects!

Winnie

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