Wednesday, March 24, 2010

In Which I Discuss My Son's Liver, But Avoid Discussing His Poop (Mostly)

2 days after we got discharged from the hospital, Sam had his first doctor's appointment. Dave and I left Jack with my mom, and brought our newest little man back to the hospital to see the nurse.

Can you guess what the first thing she said was? Aside from commenting on how freaking adorable he is, and asking him if he wanted to pretend to be a nurse and stay there with her, I mean (don't worry I told her that his answer was "No deal!").

Yup, that's exactly right. He's jaundiced. Quite obviously jaundiced. Now, when Jack was a baby I thought he was jaundiced just by looking at him, but the nurse hadn't been concerned. I had remembered Jack being more yellow in color than Sam was. But Jack had been one day older than Sam at his appointment, and apparently that one day means a lot when you're talking about a newborn's liver.

Other than the jaundice, though, everything else was looking good (see how I avoided mentioning his poop, there?), so she sent us down to the lab to get an exact bilirubin count. I was so not looking forward to them having to take his blood! He did great, though- he woke up with a scream when they pricked his heel, but almost immediately fell back to sleep as they filled the vial. I was not thrilled when the nurse called us with the results. His bilirubin level was not in the danger zone, but it had climbed 10 points since we had been discharged from the hospital and it was high enough that we had to start feeding him every 2 hours to help him flush it out. Every 2 hours around the clock. So, for the next 48 hours I watched the clock and fed him as much as I could. He was a very sleepy newborn and it was so hard to get him to wake up to eat! After dealing with a crazy kid like Jack, who never slept and wanted to eat every 1.5-2 hours this was so new to me. I never thought I'd be bummed to have a kid that did not want to eat every 2 hours!

The nurse explained to me that it was normal for their levels to go up, since the liver doesn't start kicking in until they're 6 days old. Until then, the way to break down the bilirubin is lots of feeding and indirect sunlight. 2 days after his appointment we had to have his levels rechecked, and we were pleased to see that his level had gone down, if only slightly. We had to go back 2 days after that to have it checked again, and were thrilled when his level was even lower! We could start feeding him on demand, rather than every 2 hours around the clock!

Two weeks later, though, Sam was still very yellow! I knew that sometimes jaundice tends to linger and I wasn't incredibly concerned, but Sam also has a huge gut. And by huge gut, I mean a huge gut. I mean he looked like he swallowed a cantaloupe! I know that this also isn't terribly uncommon in babies, and I wasn't incredibly worried about this either, but the combination of these two issues was making us nervous! His little liver was obviously not taking care of all that bilirubin, as he was still jaundiced, and what if the swollen belly was due to a liver issue as well?! So I sent an email to his pediatrician, and she immediately had her nurse call us to have us come in that day.

She asked about his stools and was glad when I told her they were normal (couldn't avoid the poop completely, sorry!) She felt his belly and said that his organs all felt normal, but she could feel that he had a lot of gas in his belly! Poor baby! We are pretty sure that the gas has a lot to do with my hyperlactation syndrome, but I've given up milk and cheese for a while, just in case (which absolutely sucks, since my philosophy is that if it doesn't have cheese, it's not worth eating! But I'll do anything for my little boy!). She said that when jaundice lingers, it's due to breastmilk jaundice- they don't really know what breastmilk jaundice is, but babies with that type of jaundice tend to be jaundiced for a lot longer. Just to be safe, she sent us to the lab for some bloodwork, including another bilirubin test, of course. His poor little heels have been poked and bled so many times, I feel so badly for him!

And he had to get poked again the very next day! When Dr. Jen called with the results of the blood tests, she said that they wanted to get another test for anemia because one of the samples had clotted before it even got back for testing! His bilirubin had gone up slightly, but she said that the numbers could account for lab error and she wasn't concerned about that- the numbers are still below the danger zone and they shouldn't go up any more, but she wants us to get him rechecked at the end of this week to be sure. Then she asked if Sam was "red" when he was born. He definitely was! The lactation consultant commented that he was a warm baby and said "no clothes for him!" and Dave had been concerned about his red coloring, too! Apparently this is another factor that contributes to his prolonged jaundice, as Dr. Jen said "Those 'red' babies tend to be jaundiced longer, because they have a lot of extra red blood cells at birth." When the red blood cells die off, the liver gets a little overloaded and has to work hard to keep up. And the results of Sam's anemia test... he's not anemic, but just barely. His anemia level is at the very low end of normal. We don't have to be concerned about this, but this could be another factor contributing to his prolonged jaundice. If he had one or two of these issues, he'd probably be less yellow by now, but since his poor liver has three strikes against it the yellow continues.

So, the saga of Sam's liver continues... Friday is his next blood test- please pray for good results!

Sam wears yellow well, though. Doesn't he?


  1. I will keep him (and you since you have to keep seeing him pricked) in my prayers. Please let me know how his levels are!
    Love ya!

  2. He looks so sweet and innocent in the last photo. So adorable.
    Love, mom