The suckyness that is ABO incompatability and the incredible resilience of Marty Roo

I realise that I tried to get the last post out too quickly and didn't really explain what the problem was with Marty or why we were stuck in hospital so long (and why we're having a hell of a time now that we're home).

ABO incompatibility is a problem that's restricted to mothers who have type O blood who give birth to children with A, B or AB. Marty is A+ (same as me, heh) and Jo is O+. The Rhesus factor isn't an issue here so the negatives or positives mean nothing. Basically, during pregnancy, Jo produced antibodies against Marty's blood. These antibodies produced by type O mothers are the only ones small enough to cross the placenta. So rather than just the usual jaundice you'd expect from your average baby breaking down their excess blood into bilirubin, he has the added bonus of a dose of these antibodies against his own blood in his system fervently attacking his blood and making even more bilirubin.

We're lucky they identified it early because the antibody response occurs in the serum, not the tissues, so the jaundice yellowing doesn't show until their levels are dangerously high. On his first test (24 hours I think) he was already in the red zone so from that point on we had to keep him under UV light and laying on a UV pad (called a wallaby for some reason that no one seems to know) 24 hour a day, only bringing him out for feeds. No cuddles, no clothes, just lot of screaming. The poor bugger had velcro taped to his head to hold a blindfold in place.

In the lightbox with his blindfold on

The problem with the high bilirubin levels, aside from the obvious risk of brain damage, is that they make him really sleepy. The problem with that is the way to clear the bilirubin is to break it down in the liver which is too young to cope with those levels, or with UV light. But to totally clear it from the system it binds to protein and is passed out with the poo. If there's no poo it get's reabsorbed. His levels are so high that it is almost impossible to wake him for a feed and if you do he's too tired to suck and loves the contact after being in the tank that he just snuggles in happily. We were so desperate for him to be well that we followed their advice and supplemented feeling with formula (from a syringe and only after a feed) which got his levels plateaued by day 3 and kept his weight up enough for us to be released.

Finally leaving our postpartum room

So they sent us home with a wallaby under strict instructions to keep him on it as often as possible, so still no cuddles and no clothes, but at least he wasn't stuck in the tank so we could interact with him more. It should have been a relief to be home, and at first it was wonderful, but last night was the worst night of all. Almost nothing we tried would wake him enough to feed. It was so awful to have to basically torture him awake, and horrible to see him lying limp like that. Even the formula, which he'd taken relatively easily in hospital, was a battle and he spat most of it back at me (kind of relieved he doesn't like formula to be honest). He was so hungry and so frustrated that he just screamed and fought and didn't poop!

Our light therapy setup at home

However, this morning we reassessed the whole situation. Clearly squirting formula down his throat wasn't working, neither was trying to force him onto the breast, especially when we needed output (yes, I mean poop, and lots of it). So now we've got Jo pumping (and doing really well) and mimicking the way we'd expect him to feed if he were healthy. Luckily she's a born dairy queen! Now we've ditched the formula entirely and have him drinking loads of breast milk about every 2-3 hours (slow-flo bottle, much kinder than the syringe and he at least learns to suck for food) and he's already much more alert and pooping!! I nearly cried with joy when we had an explosive non-meconium poo! I'm sure I'll start hating them but for now it was better than a Christmas present.

Now we just keep him feeding and when he's not feeding we keep him on his little glow worm pad and hope for the best. We see our pediatrician (who we love, luckily, because you can't meet them until you have a baby!) on Monday and he'll make then next call based on his weight (he went from 8-3 to 7-10 in the first 2 days but leveled out after that), his 'output' and a bilirubin test, which of course means more foot torture. I have no idea how soon we'll know the outcome but we'll keep you posted. For now, please bear with our slow response time and keep sending pooping thoughts!

Marty Roo feeling a bit better!