Brief Answer:
Yes, it can return and needs to be treated properly.

Detailed Answer:
hello Mrs XXXX,

Thanks for posting your question here.

Jaundice in newborn babies is normal, but it should be within a certain acceptable range.

Your baby, since she was born prematurely, she is at a risk of developing jaundice which might become serious.

The jaundice in neonates is most often is due to physiological reasons, that is, the haemoglobin produced while in the uterus is not suitable after birth and hence needs to be destroyed and replaced by the adult type of haemoglobin, and this sudden destruction of large amounts of haemoglobin leads to a natural increase in the levels of bilirubin levels (this bilirubin is the yellow substance that causes the yellow colour in jaundice, and bilirubin is the end product of haemoglobin destruction).

But this is exaggerated in premature babies because their liver is immature and can not handle the increased levels of bilirubin effectively.

So it is very essential to make sure that the bilirubin is eliminated from the blood before it crosses the normal acceptable limit for the gestational age of your baby.

There are multiple other contributing factors which may increase the bilirubin levels and make it worse, particularly in premature babies like infection, Rh or ABO incompatibility etc.

It is unwise to discharge a preterm baby who developed jaundice so early from the hospital.

She should ideally be monitored closely and her bilirubin levels need to be checked at least once a day to make sure they are within the acceptable range.

I am explaining all this and emphasizing the need for better management of bilirubin because, particularly in preterm babies, the blood brain barrier is not well developed, so the increased bilirubin crosses into the brain, and if it crosses into the brain, it can cause permanent brain damage which is called kernicterus.

Meanwhile, keep breast feeding your baby every 2 hours once, regular and adequate breast feeding reduces the risk of worsening jaundice.

Please consult a neonatologist as soon as possible or go back to the hospital and get phototherapy done again.

I hope this answers your question adequately. Please do write back to me if you have doubts.

Best wishes.

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Brief Answer:
11.9 at 1 week is acceptable, exposure to light will help.

Detailed Answer:
Hello again XXXX,

Thank you for updating me with the details.

Your baby is 1 week old and her present bilirubin level is 11.9 and she is otherwise well. With this background, there is no need for admission now. Her bilirubin levels are within the normal range for her age.

Yes, exposure to blue light does reduce bilirubin levels, but it is not required now as her bilirubin is not high enough to require phototherapy.

You do not need to expose your baby to blue light at home.

Your baby will require around 50 ml of milk per feed, please keep feeding her directly from the breast, I understand that she had some difficulty feeding initially, but if you keep trying to feed her directly from the breast, now she will be able to suckle properly.

The most important factor for adequate breastfeeding is, proper position.

You need to support your baby well, head, neck, back and legs all must be supported well.

Her whole body must be turned towards you while feeding, not just head.

She must be held close to your body.

You must be sitting or lying down in a comfortable position, if needed, with proper support.

Latching on to the breast is also important.

Your baby should open her mouth wide and at least 3/4 of the areola (dark area surrounding the nipple) must be inside the mouth of your baby.

She must press the areola and not just suck on the nipple.

She must gulp down the milk intermittently.

Her lower lip must be turned outwards and her chin must touch your breast.

These are good signs of good attachment and proper positioning.

You can watch videos of proper position and attachment for breastfeeding on youtube. WHO has released such educational videos and are easily available on Youtube.com. (Search for Positioning and attachment for breastfeeding tutorial).

You must continue to feed your baby every 2 to 3 hours once, that is correct.

You must remember to feed her from one breast for at least 15 to 20 minutes, because the milk that comes out in the initial 5 to 10 minutes is more watery and has less nutrition and it is called foremilk, if you change sides frequently then your baby will get only fore milk which is not very nutritious, but will fill her stomach with more water.

The hind milk is also essential and if you continue to feed from one side each time, then your baby will get the thicker hind milk.

I hope this clarifies your doubts.

Best regards.

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Brief Answer:
You need to keep her awake while she feeding from breast.

Detailed Answer:
Hello again XXXX.

Thank you for writing back with more details. I understand your problem better now.

Babies usually fall asleep while feeding, and that is one of the reasons for them not feeding adequately.

You must keep her awake while she is feeding from the breast directly by stimulating her by rubbing the feet, touching her and talking to her.

If you do this, she will feed continuously for longer periods which will give her both foremilk and hind milk.

Some babies do feed only from one side, the exact reason for that is unknown, but I have come across such babies, what you can do in that case is, express the milk from the right side every 4 hours once, that is about two hours after feeding from the left side and feed your baby by a spoon or palada once every 4 hours. That way your milk production will keep increasing and once your baby is a little older (about one month), you can feed her from right side once and from left side once.

Feeding with the spoon maybe a bit difficult, you can use a palada (a diya like metal infant feeding cup), children feed better with this.

Do not worry, your baby's needs at this moment are easily fulfilled by feeding her from one breast, and as she grows older, (4 to 5 months), she will automatically feed properly as her needs increase at that time. Till then feeding every 2 hours once from one side is also quite sufficient.

There is nothing to be worried or tensed about, everything will be fine.

Drink a glass of water before feeding your baby and do not follow any dietary restrictions. Many elderly women in the family will tell you not to eat this and that, but do not listen to them, you must eat everything your were eating before without restrictions, you actually need almost 1 and half times the food you were eating before.

I hope I have answered your questions. I will be more than happy to help you further if you have any more doubts.

Wishing you a happy motherhood and good health both to you and your daughter.

Warm regards

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