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Child lost weight after birth, increased total serum level, yellow urine and stools, yellow face and eyes. Suggestions? - Online Doctor Chats

Date : 11-Jun-2013
User rating for this question
Very Good Posted in: Child Health
Answered by

General & Family Physician
Practicing since : 2002
Answered : 106 Questions
User:hello doctor
Doctor:Dr XXXXXXX here
User:good afternoon
Doctor:How can I help you?
Doctor:Good afternoon
User:Dr. XXXXXXX I had a baby delivered on 15th mar
User:having wieght 3 kg at time of birth
User:now the baby was again wighed by child specialist and found to be 2.6 kg on 21-03-13
User:the baby had 15.7 total serum counting for joindice on 19-03-13
User:and now it has increased to 19
User:please suggest
Doctor:May I know if the child has any noticable signs of jaundice such as yellowish discoloration of sclera.
User:yes the baby has yellowish urine and yellow potty with liquid content in it
User:his face is yellow and eyes are also yellow in colour
User:we had consulted child specialist for this on 21-03-13 but he said everything is fine dont worry
User:and started his regular vaccination
Doctor:Let me brief you.
Doctor:What your child has is normal and occurs with every child.
Doctor:As long as the levels are under 30mg/dl, the child would not have any serious problems.
Doctor:Such elevated bilirubin levels can persist for 2 weeks of age.
Doctor:So do not be worried about the current bilirubin levels.
Doctor:expose him to early morning sun light for 15-30 minutes and watch him grow normally.
User:now we had a word with doctor & he has asked us to put our baby in nursery
User:for 2 days
User:it seems to be odd now
User:that doctor has suggested everything as normal on 21st & now asking us to admit him to nursery
Doctor:Did you speak to the doctor about the reasons for admission?
Doctor:Is it for phototherapy.
Doctor:Do not be worried about the use of phototherapy. Bilirubin levels of 19 is just under limits at this age.
Doctor:Phototherapy will help in lowering the bilirubin levels.
Doctor:I would be concerned if your child is lethargic, not feeding well and running fever.
User:no fever, is not lathergic & is feeding well
Doctor:What he seems to have is an exaggerated physiological jaundice and can be treated well and effectively with phototherapy.
Doctor:Have you followed?
User:yes doc
User:well are there any side effects of phototherapy
Doctor:Phototherapy is well tolerated by most babies. Some babies have increased bowel movements. Over exposure may cause some local skin tanning.
Doctor:Such side effects are rarer.
User:what is recommended duration to have the baby put on phototherapy?
Doctor:Phototherapy sessions may last for 30minutes to more than an hour.
Doctor:Sessions will be repeated as per needs of the baby.
Doctor:And as per settings of phototherapy unit.
Doctor:His pediatrician will know about those settings and will accordingly instruct the nurse in charge to use them.
User:any other things to consider
Doctor:As far as the current circumstances, there are no priorities / restrictions.
Doctor:You will be asked to nurse the child regularly.
Doctor:The levels of bilirubin will be watched and monitored.
User:actually we have been releaved from hospital since 21-3
User:and now are at home
Doctor:In the case if the bilirubin levels fail to reduce you may be asked to reduce feeding and other enzyme supplements will be provided to him.
User:everybody says its ok but the increased levels are causing concerns to me
Doctor:Do you mean the phototherapy sessions are over?
User:21st baby was detected with joindice
User:15.7 rating & today out of my own curiosity we have checked it
User:so in 2 days time the levels have increased to 19
Doctor:I can understand your anxiety as a mother;
User:with this increased level, we have consulted the pediatrician and he has suggested putting him in nursery
Doctor:but what you son has is seen in each and every child.
Doctor:Even you would have had it as a child.
User:now my mother has taken the baby to doctor for treatment
Doctor:Physiological jaundice that happens with every child can last for 2 weeks. Extended / exaggerated jaundice can persist for even a bit more time.
Doctor:A higher level is bound to be seen when you get the levels checked within this time frame.
User:does it persist with these high level of serums?
Doctor:Instead of you performing blood test, I suggest you to just monitor your child physically.
Doctor:Watch and monitor the amount of yellow discoloration of skin and eyes.
Doctor:A higher bilirubin values will increase the yellow discoloration of skin and sclera (eyes).
Doctor:if you feel the discoloration has increased, please confirm with pediatrician to confirm.
Doctor:Your pediatrician by his experience can be able to predict the levels of bilirubin clinically.
Doctor:A repeat test can be ordered if your pediatrician agrees.
Doctor:Trust your pediatrician and he will guide you when to get repeat test.
Doctor:Do you have any other query?
User:well doctor thanks for the advise
User:and your support
User:one last thing to ask is
User:what is direct serum & what is indirect serum counting means
Doctor:You would need to understand bilirubin metabolism to know the difference between direct and indirect bilirubin.
Doctor:To simplify, direct and indirect bilirubin refers to two forms of bilirubin.
Doctor:The first one (direct) is a conjugated form attached to another molecule and indirect is which is unattached.
Doctor:The attachments takes place in the liver.
Doctor:The ratio between the total bilirubin and direct bilirubin levels help us identify the causes of jaundice.
User:now in this case my baby has direct serum count as 1.0
User:& total count as 19.5
User:so could u identify anything out of it
Doctor:Physiological jaundice which occurs in every new born has higher than normal total bilirubin and indirect bilirubin.
Doctor:Direct bilirubin will either be normal or marginally raised when compared to the other ones.
Doctor:This description matches your sons values; higher total bilirubin and indirect bilirubin with marginally higher direct bilirubin.
Doctor:I hope you are able to understand.
Doctor:Do you have any doubts?
User:yes doc
Doctor:Do you have any other query?
User:well this coversations leads me to understand that liver of the baby does not perform to the requirements and leads to joindice
User:and slowly with help of his cries & body movements he may be in position to recover
User:phototherapy would help him produce vitamine A in his body
User:to assist liver in performing its job
Doctor:That is a good analysis; but the fact is
Doctor:the type of hemoglobin in a new born is different from adults.
Doctor:It changes to adult form soon after birth.
Doctor:Therefore the old baby form of hemoglobin also known as HbF is destroyed and new adult for of hemoglobin (HbA) is produced.
Doctor:The destruction of old form of hemoglobin is metabolized to bilirubin.
Doctor:Therefore it is not that liver is not functioning properly, it is just that there is over production of bilirubin.
Doctor:The over production will soon be removed and excreted.
Doctor:And in an average that takes about 2 - 4 weeks.
Doctor:Phototherapy is a means to assist liver. The radiations in the phototherapy unit chemically changes bilirubin to easily excretable product.
Doctor:Therefore the jaundice that you see in your son is just a transition that is happening within him from some one inside your womb to a normal individual living on this earth.
Doctor:You should not be concerned and worried with this transition.
Doctor:Hope it is clear.
Doctor:Do you have any other query?
User:no doctor
User:thanks a lot for your advise & clarifications I feel satisfied now
Doctor:Thanks for consulting me.
User:thank you..
Doctor:Bye for now.
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