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Battle with the Bilirubin

by Nikki Montgomery

On the third day of life babies get their bilirubin checked. Bilirubin is a yellowish brown substance in the blood that is caused by the liver breaking down old red blood cells. It is passed through the body through feces. When there is too much bilirubin in the blood it causes the baby's skin and whites of their eyes to turn yellow, jaundice. My girls looked like little sweet potatoes.

If bilirubin counts get really high it can cause serious problems like brain damage, hearing loss, physical abnormalities, damage the muscles that move the eye and even death. This level is different depending on what type of jaundice it is.

On the 3rd day the girls' bilirubin counts were not too bad, but it continued to go up and their weight continued to go down. That's not a good combination. Saturday day 4 Zoey's bilirubin count was up to 18.6 and her weight was down 11.7% (doctors don't like to see any more than a 10% weight loss), Kenzie's bilirubin count was up to 15.6 and her weight was down 11.1%. This was a sign that we needed to get the girls on biliblankets and under a bilirubin light.

Due to the weight loss the lactation consultant Lora Harris came down to my room to make sure that the girls were latching on okay when breastfeeding and that they were eating enough. It's hard to measure how much they're eating when breastfeeding so after breastfeeding both girls she asked me to pump to see if I could still get some milk out and I did so that indicates that I am producing enough milk. The problem seemed to be that the girls were so sleepy they were having a hard time staying awake to eat and waking up to eat. Kenzie had a hard time eating because she was super stuffy. We have to suck the stuff out of her nose before each feeding. 

We were supposed to go home Saturday, but because of the jaundice we were asked to stay another day. By Saturday night their bilirubin count had gone down significantly, so we kept them on the lights overnight and another blood draw was scheduled for morning. 

Sunday their 5th day, Kenzie's bilirubin had gone down to 13.6 and Zoey's 14.1 so Dr. Hay, the pediatrician who checked in on them gave us the option to stay another day or to go home with the biliblankets. We chose to go home to Mia. We had to come back on Monday for another bilirubin and weight check and the bilirubin had gone up and their weights went down. So the plan was to stay on the home biliblankets and come back the next day for another weight check and bili check. Tuesday at the clinic their weights stayed the same as Monday and their bili counts went up again.  

We had a home visit with a Ministry Saint Michael's nurse scheduled for Wednesday so she weighed the babies and took their blood for bilirubin counts. She told us as she was leaving that it would be a few hours before we heard from the nurse so we waited anxiously to hear if they'd improved. We had them on the home biliblanket for three days at this point and Ministry Home Care even came by and brought us newer versions Tuesday night because they thought the ones we were on may have been a little weak. We had high hopes, but when the nurse called from the hospital around 3pm and told us that their counts went up again we were disappointed. Zoey was at 17.7 (her highest level was 18.6) and Kenzie was at 19.3 (her highest level yet). She told us we needed to get back to the hospital and the babies would be readmitted into the Women and Infant Center. 

I was actually really glad to hear they'd be back in WIC where they were born instead of being put into the pediatric unit on the 5th floor. We were already familiar with the nurses and CNAs so it was much more comforting that they were also familiar with our girls. Even though we weren't back under good circumstances we were all smiles when we were greeted by our nurse friends. 

Dr. Kasukonis, the pediatrician who was there during delivery, ordered a bili check 6 hours after we arrived, weight checks and even went so far as to have the nurses weigh dirty diapers to try to track how much is coming out since we can't measure how much is going in because I'm breastfeeding. The first bilirubin check was at midnight and Kenzie was down to 18.6 and Zoey was at 16.3. We were glad to see that, but had honestly hoped it would've dropped more. 

This morning they came back to do another bili check and to check weights again. Zoey's weight had gone up to 5 pounds 11 oz which was up 3 oz in two days. Kenzie was up to 5 pounds 2 oz which was up 2 oz in two days. Those were good numbers, but we hadn't seen the bilirubin numbers yet. Josh told the nurse, Lisa, last night that we really wanted a 10. Lisa came in this morning and said she was excited to bring us good news before she was off for the day! Zoey's bilirubin was down to 10.7 and Kenzie's was 10.8! 

Dr. Kasukonis came in this morning to check on the babies and was happy to see the numbers had dropped so much. He told us that they'd take the overhead lights off of them, but keep them on the blankets for the day. He will be back tonight at 6 to check on them again. I anticipate that lab will be here around 5 for another bili check. We hope we'll be able to go home tonight, but there's a chance we'll stay another night and go home in the morning. Either way we'll be keeping the babies on the home biliblankets for a while and probably running back and forth to the clinic over the next week.

All I can say is that during this stressful time it is so nice to have nurses and CNAs telling me that I'm doing a good job because it is tough knowing that the only way they're going to get through this is by me feeding them often. 

Thanks Lori, Lisa, Emma, Emily, Anne, Lindsey, Dr. Kasukonis and anyone else I may have missed for our readmission.

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