On Newborn Jaundice and Having A Direct Coomb's Test Positive Baby

January 17, 2018

The past eight weeks had been very challenging for our family, especially since we have a newborn to take care of.  So yeah, we're pretty much busy with feeding, burping, changing nappies, and trying to catch up some sleep!  So far, so good!  Joaquin is an easy baby, at least compared to his Kuya Rafa, who never slept longer than 3 hrs without a feed until he was three years and 5 months old.  It's hard, but I guess that experience prepared me to expect the worst (in terms of sleeping habits) with my second child.  Now, I'm grateful and happy to enjoy 2-3hrs (or sometimes even 4hrs) of sleep with Joaquin.  Thank you, dear God!

I'm very grateful that I didn't have issues with breastfeeding and sleeping this time around.  However, what worries me is that my baby was diagnosed of being DCT+ (Direct Coomb's Test positive) at birth.  For those of you who don't have a medical background, I've summarized the important points about this condition below: 

What does it mean when a baby is coomb's test positive?

It means the baby's blood has antibodies that attack their red blood cells.  This happens when blood groups differ -- the mother's blood sees the baby's blood as different and produces substances called "antibodies" which can cross the baby's bloodstream and destroy the baby's red blood cells.

What problems can occur for a baby when a Coombs test is positive?

There are two main problems that can happen in babies when a Coombs test is positive:  anemia and jaundice.

Anemia means there are fewer than normal red blood cells (RBCs), the component of the blood responsible for delivering oxygen to the body tissues.  Coomb's positive babies can develop anemia over the first few weeks/months of life because their RBCs are broken down by the antibody from their mother.  Severely anemic babies appear pale, feed poorly, can be very sleepy to the point of lethargy and have elevated rates of breathing and heartbeats.  Hence, they may need oxygen, IV fluids and blood transfusion.

Jaundice, on the other hand, is the yellowish color of the skin and white parts of the eyes caused by the build-up of bilirubin in the baby's bloodstream.  Bilirubin is released when red blood cells are broken down.  While most newborns develop mild jaundice, Coombs positive babies are at greater risk of having higher levels of jaundice which needs to be treated with phototherapy.  If left untreated, the very high level of bilirubin in the blood can cause brain damage called "kernicterus" and other serious lifelong problems.

What will happen to my baby?

A blood test, along with physical examination, will be taken to monitor the baby for anemia and jaundice.  While you cannot do anything about how often they need to draw blood from your precious little one, it is vital to keep working on feeding because poor feeding can worsen jaundice. If your baby is at higher risk of developing anemia, they will be prescribed with Folic Acid (the medicine used to make new RBCs) which needs to be taken for 3-4 months.

*Reference:  My baby is Coombs positive. What’s D.A.T.? (2016, April 26). Retrieved from:  https://childrensmd.org/browse-by-age-group/baby-coombs-positive-whats-d-t/

*The photos above were taken at Burjeel Hospital's Baby Clinic when Joaquin was just four days old.

My husband and I can't help but remember the time when Rafa had to be admitted to the hospital for phototherapy on day 3 because of hyperbilirubinemia, which could have been prevented if he was fed well.  The doctors and nurses in that hospital, where I gave birth, were very strict in implementing breastfeeding among new moms.  My son's pediatrician even reprimanded me for supplementing him with formula because obviously, I was having a problem with my supply back then.  While I must agree that breast is best when it comes to baby's nutrition, I also believe that healthcare professionals should be aware of the dangers of insufficient exclusive breastfeeding so as to avoid unnecessary admission and long-term problems in babies. 

Anyway, we're scheduled for another follow up with Joaquin's neonatologist this coming weekend. We visit him every 2 weeks to have our baby's bilirubin and hemoglobin monitored.  (When we were still in the hospital, they had to do blood test every 24, 48 and 72 hours.) Can you imagine just how many times they've pricked my son already?  

The experience may be daunting for me as a mother and traumatic for my newborn son.  But I am thankful still because despite my baby's mild jaundice during the first month and mild anemia on the second month, his test result was still far from those levels that require treatment.  All thanks to the Heavenly Father for His unending grace and also to Joaquin's neonatologist for educating us on how to properly manage our son's condition!  

We hope our son will be a perfectly healthy baby sooner!  As per my readings, the antibodies which caused his positive Coomb's test are said to reduce in number and are usually gone in the baby's blood by 2 months of age.  We're crossing our fingers for normal blood test results on Saturday!  Please help us pray for our son.  Thank you!!!

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