Jaundice

• Pertinent facts:– What happened: Onset of jaundice that

progressed the next day.– Test done: Serum bilirubin determination– Result: Bilirubin level of 12 mg/dL– Treatment done: Phototherapy

Differentials of Jaundice

• Breastmilk Jaundice– Immediately ruled out due to time of onset

• Physiologic Jaundice– Inconsistencies:• The PEAK rise of bilirubin levels in physiologic jaundice,

should not exceed 5 mg/dL/day • PEAK of bilirubin level is less than 13 mg/dL

– At onset, bilirubin of the baby is at at 12 mg/dL.

Diagnosis

• Breast feeding Jaundice / “Lack of breastfeeding” jaundice– Caused by insufficient breast milk intake– Infants born by cesarean section are at a higher

risk – Baby is under parenteral nutrition• What was fed (glucose water) might have caused

hyperbilirubinemia

– Onset was on the 1st Week of Life

Phototherapy: Beneficial or Not?

• The baby is still under mechanical ventilation and unable to breastfeed

• In phototherapy, bilirubin in the skin absorbs light energy, causing several photochemical reactions which would allow unconjugated bilirubin to be excreted in the bile without conjugation

• Conclusion: baby should be treated with phototherapy until such a time that he can be breastfed properly.

Food Intolerance• On the 48th Hour of Life

– Action done: Minimal enteral feeding was started with 2 mls of expressed breastmilk every 3 hours

– What happened: Abdomen became distended– Response: Feeding was stopped

• On the 72nd Hour of Life– What happened: He was successfully taken off the ventilator and

extubated– Actions done: Feeding was resumed with 2 mls of expressed

breastmilk every 2 hours.– Response: Feeding was tolerated well.

• Further Action: Feeds were gradually increased over the next 3 days until he was able to tolerate 20 mls every 3 hours.

Food Intolerance

• Considered a complication in enteral feeding• Baby is preterm and its digestive system might

not have been yet fully developed • The feeding was stopped and resumed a day

later– now tolerated.

Stakeholders

Psychosocial and Economical Impact

Father

• Little to No Influence• Second to the mother, he is perhaps the most

affected• Feelings of guilt • Feelings of helplessness • Added burden of responsibility • Economically, it has little impact on him as of

now

Siblings

• Competition for resources• Feelings of Envy• Feelings of protectiveness

Hospital Healthcare Team

• Impact on Reputation impacts financial standing– If Baby dies• Bad reputation -> Less patients -> Less income

– If Baby gets well• Good reputation -> More patients -> More Income