Asi mempengaruhi kadar bilirubin?
Sent: Thursday, December 01, 2005 3:11 PM
Subject: [sehat] (Tanya) Asi mempengaruhi kadar bilirubin? (help pls)
Dear SP’s dan dokters, penasaran sama cerita temen kantor yang
anaknya (3 minggu) kuning…
menurut keterangan dokternya kemungkinan ada ketidakcocokan asi
sehingga membuat kadar bilirubin sianak naek (waktu keluar dari RS
7, setelah 3 minggu naek menjadi 9)
yang bikin saya kaget, kok ternyata ada ya bayi yang tidak cocok
sama asi ibunya
apa mungkin sech dok? setau saya bukannya asi yang paling bagus
untuk si anak
untuk sementara saat ini si baby diberi obat puyer untuk menyerap
dan tidak diberi asi, untuk ngetes apa betul asi yang membuat kadar
bilirubin si anak naek
saya sampe ga sabar pengen nanya ke milis, dalam hati saya kok
sayang yaa kalo ga diberi asi
berikut saya copy paste langsung dari keterangan dia
bilirubin.. wktu pertama 10,7 setelah sinar 2x24jam jadi 7…
setelah 2 minggu naik jadi 9 sekarang.. dimana bilirubin langsungnya
sekitar 27% sisanya bilirubin tidak langsung.
minum susunya tetap kuat baik formula maupun asi….
tapi anak gua sendiri lebih doyan asi….
sekarang minum 120ml kadang lebih.
kotoran warna kuning.. lembek bukan mencret.
hasil test darahnya gavin…
sgot 51 normalnya 56
sgpt 30 normalnya 77
gamma 305 normalnya 204
bilirubin total 9 normal 1-12
bilirubin direct 2,51
bilirubin indirect 6,49
mohon pencerahannya ya don dan sp’s
terima kasih byk
Sent: Thursday, December 01, 2005 3:55 PM
Subject: [sehat] Re: (Tanya) Asi mempengaruhi kadar bilirubin? (help pls)
Memang ada kemungkinan beberapa bayi dengan full ASI bisa mengalami
kuning, biasanya disebut “breastmilk jaundice”.
Disebabkan karena adanya kandungan semacam “lemak” pada ASI yg
memperlambat proses eksresi/pembuangan bilirubin ke usus.
Breastmilk jaundice biasanya terjadi mulai hari ke 7 dan mencapai
puncaknya pada usia 10~21 hari dan akan hilang dengan sendirinya
dalam 1 ~2 bulan.
yang perlu diingat, hal ini adalah kondisi normal
Selama kondisi dan aktivitas bayi sehat, tidak diperlukan terapi,
obat ataupun suplemen lainnya
Tatalaksananya, teruskan pemberian ASI karena benefitnya lebih besar
jikka dibandingkan bila di stop ato diganti formula.
buat Dokters, cmiiw….
From: Luluk Lely Soraya I
Sent: Wednesday, December 07, 2005 10:04 AM
Subject: Re: [sehat] (Tanya) Asi mempengaruhi kadar bilirubin? (help pls)
Dear Mbak Seni,
Hmmm saya hampir yakin yg dimaksud oleh teman mbak ataupun dokternya
adalah Breastfeeding Jaundice ya ?!
Jika memang iya, justru ASI harus terus diberikan.
Tidak boleh distop.
Breastfeeding jaundice hingga saat ini belum diketahui penyebab pastinya.
Tapi bukan berarti mengindikasikan ASI sang ibu gak cocok dg sang bayi,
Nah ini misconception yg totally salah.
OK saya postingkan artikel berikut.
Semoga membantu kekhawatiran dari teman mbak ya.
Keep breastfeed !
Breastfeeding and Jaundice
Handout #7. Jaundice. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
Jaundice is due to a buildup in the blood of bilirubin, a yellow pigment
that comes from the breakdown of old red blood cells. It is normal for old
red blood cells to break down, but the bilirubin formed does not usually
cause jaundice because the liver metabolizes it and gets rid of it into
the gut. The newborn baby, however, often becomes jaundiced during the
first few days because the liver enzyme that metabolizes bilirubin is
relatively immature. Furthermore, newborn babies have more red blood cells
than adults, and thus more are breaking down at any one time. If the baby
is premature, or stressed from a difficult birth, or the infant of a
diabetic mother, or more than the usual number of red blood cells are
breaking down (as can happen in blood incompatibility), the level of
bilirubin in the blood may rise higher than usual levels.
Two Types of Jaundice
The liver changes bilirubin so that it can be eliminated from the body
(the changed bilirubin is now called conjugated, direct reacting, or water
soluble bilirubin–all three terms mean essentially the same thing). If,
however, the liver is functioning poorly, as occurs during some
infections, or the tubes that transport the bilirubin to the gut are
blocked, this changed bilirubin may accumulate in the blood and also cause
jaundice. When this occurs, the changed bilirubin appears in the urine and
turns the urine brown. This brown urine is an important clue that the
jaundice is not “ordinary”. Jaundice due to conjugated bilirubin is always
abnormal, frequently serious and needs to be investigated thoroughly and
immediately. Except in the case of a few extremely rare metabolic
diseases, breastfeeding can and should continue.
Accumulation of bilirubin before it has been changed by the enzyme of the
liver may be normal—”physiologic jaundice” (this bilirubin is called
unconjugated, indirect reacting or fat soluble bilirubin). Physiologic
jaundice begins about the second day of the baby’s life, peaks on the
third or fourth day and then begins to disappear. However, there may be
other conditions that may require treatment that can cause an exaggeration
of this type of jaundice. Because these conditions have no association
with breastfeeding, breastfeeding should continue. If, for example, the
baby has severe jaundice due to rapid breakdown of red blood cells, this
is not a reason to take the baby off the breast. Breastfeeding should
continue in such a circumstance.
So-called Breastmilk Jaundice
There is a condition commonly called breastmilk jaundice. No one knows
what the cause of breastmilk jaundice is. In order to make this diagnosis,
the baby should be at least a week old, though interestingly, many of the
babies with breastmilk jaundice also have had exaggerated physiologic
jaundice. The baby should be gaining well, with breastfeeding alone,
having lots of bowel movements, passing plentiful, clear urine and be
generally well (handout #4 ). In such a setting, the baby has what some
call breastmilk jaundice, though, on occasion, infections of the urine or
an under functioning of the baby’s thyroid gland, as well as a few other
even rarer illnesses may cause the same picture. Breastmilk jaundice peaks
at 10-21 days, but may last for two or three months. Breastmilk jaundice
is normal. Rarely, if ever, does breastfeeding need to be discontinued
even for a short time. Only very occasionally is any treatment, such as
phototherapy, necessary. There is not one bit of evidence that this
jaundice causes any problem at all for the baby. Breastfeeding should not
be discontinued “in order to make a diagnosis”. If the baby is truly doing
well on breast only, there is no reason, none, to stop breastfeeding or
supplement with a lactation aid, for that matter.
The notion that there is something wrong with the baby being
jaundiced comes from the assumption that the formula feeding baby is the
standard by which we should determine how the breastfed baby should be.
This manner of thinking, almost universal amongst health professionals,
truly turns logic upside down. Thus, the formula feeding baby is rarely
jaundiced after the first week of life, and when he is, there is usually
something wrong. Therefore, the baby with so-called breastmilk jaundice is
a concern and “something must be done”. However, in our experience, most
exclusively breastfed babies who are perfectly healthy and gaining weight
well are still jaundiced at five to six weeks of life and even later. The
question, in fact, should be whether or not it is normal not to be
jaundiced and is this absence of jaundice something we should worry about?
Do not stop breastfeeding for “breastmilk” jaundice.
Higher than usual levels of bilirubin or longer than usual jaundice may
occur because the baby is not getting enough milk. This may be due to the
fact that the mother’s milk takes longer than average to “come in” (but if
the baby feeds well in the first few days this should not be a problem),
or because hospital routines limit breastfeeding or because, most likely,
the baby is poorly latched on and thus not getting the milk which is
available (handout #4 ). When the baby is getting little milk, bowel
movements tend to be scanty and infrequent so that the bilirubin that was
in the baby’s gut gets reabsorbed into the blood instead of leaving the
body with the bowel movements. Obviously, the best way to avoid
“not-enough-breastmilk jaundice” is to get breastfeeding started properly
(handout #1 ). Definitely, however, the first approach to
not-enough-breastmilk jaundice is not to take the baby off the breast or
to give bottles (see Handout B: ). If the baby is nursing well, more
frequent feedings may be enough to bring the bilirubin down more quickly,
though, in fact, nothing needs be done. If the baby is nursing poorly,
helping the baby may allow him to nurse more effectively and thus receive
more milk. Compressing the breast to get more milk into the baby may help
(handout #15 ). If latching and breast compression alone do not work, a
lactation aid would be appropriate to supplement feedings (handout #5 ).
See also the handout: . See also the website
http://www.thebirthden.com/Newman.html for videos to help use the Protocol by
showing how to latch a baby on, how to know the baby is getting milk, how
to use compression, as well as other information on breastfeeding.
Phototherapy (Bilirubin Lights)
Phototherapy increases the fluid requirements of the baby. If the baby is
nursing well, more frequent feeding can usually make up this increased
requirement. However, if it is felt that the baby needs more fluids, use a
lactation aid to supplement, preferably expressed breastmilk, expressed
milk with sugar water or sugar water alone rather than formula.
Questions? see my book Dr. Jack Newman’s Guide to Breastfeeding (called
The Ultimate Breastfeeding Book of Answers in the USA)
Handout #7. Jaundice. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code
on the marketing of breastmilk substitutes is violated
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