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