Baby jaundice emergency - what to do in Malaysia

If you have read my previous entry you would have known that my newborn baby was admitted to hospital on Day 6.

I would like to share on the chain of events in the hope that it would prevent others from making the same mistakes as me.

First you must understand that if you are breastfeeding, then do not consume any herbal medication. Read my post breastfeeding-and-eu-yang-sang-products-jaundice.

Secondly to check for jaundice, press on baby skin with your finger. It should NOT be yellow after you release the finger. The most yellow part would start from the head, follow by the chest, arm and getting less at the feet.

Also jaundiced baby are very lethargic. Will only sleep and not wake even for milk.

Medically there are a few ways to check jaundice level but the most accurate method is by blood test.

And by Malaysian standard, the type of treatment is determined by the level of jaundice.
Above 400 - blood exchange
399 - 300 - phototherapy with 2 lights
Below 200 - phototherapy with 1 light

For my case on Day 6 at night, when I went to a pediatric for checkup, the doctor using a light sensor obtained a reading of 28mg/dL approximately 490umol/l.

He immediately recommended hospital admission but did mentioned that with high jaundice level, the light sensor's reading may not be accurate. I requested for a letter. My 1st mistake.

Referral letter from the pediatric to Pantai Cheras

With the letter, I rushed to Pantai Cheras because I delivered there.

I thought with the letter, baby can be admitted immediately. I was wrong!

I was told to wait for my turn to see a general doctor before he can direct me to the proper department.

I was shocked because there were a lot of patients waiting.

The right thing I did was:-
I stood in front of the nurse and refused to take a seat even though she kept telling me to sit.

The 2nd thing I did right was IMMEDIATELY ask if there are any phototherapy light available.

The answer was None!

Imagine if I had waited!!

Having learned this, I then googled for hospitals contact and called the hospitals first to know which have available light.

Results:-
Pantai Ampang and Sunway have but Sunway will only accept the baby and not me as there's no bed for adult available. Plus priorities are given to those who delivered at Sunway.

So I rushed to Pantai Ampang. Again I have to wait at the emergency room.. And it's no surprise that there's a crowd. But the nurses fast tracked me and I got to see a doctor soon.

When she saw the report and the high reading of 490, she gave us 2 options.

First - get a blood test to confirm the level.

a) If the reading is confirmed higher than 400 then baby will need blood exchange which Pantai Ampang does not have facility.

b) If the reading is lower than 400 then we can be admitted.

It is really not an option because it takes time to do the blood test and we would have wasted precious time if the reading is indeed more than 400.

So we chose to go to a government hospital in case the reading is really that high.

Again we made a MISTAKE of asking for Pantai Ampang doctor's referral letter.

Anyway with the letter we went to HUKM as only government hospitals have the proper facility for blood exchange.

AT HUKM

Once in HUKM we waited, yes waited to see the medical officer to take the blood, then wait even more (total of 5 long hours to be exact) in HUKM for the blood test.

The level was confirmed as 361.

Good news that baby don't need blood exchange.

Bad news - HUKM do not have bed available for us.

The medical officer told us to try HKL. I immediately broke down and cried.

By God's grace the medical officer took pity on us and helped us to get a place in the maternity ward instead of the NICU (Neonatal ICU).

By 3am, Baby was finally admitted and had to go through phototherapy with 2 lights and blood test every 6 hours (taken from the wrist) to monitor the jaundice level.

So my ordeal to get him admitted began 7pm and ended at 3am (8hours) that night and through all these hours all I did was keep feeding him breast milk.

In the ward, I set alarm every 2 hours and even carried him on my chest as he sleep under the light.

Thanks to all the prayers, breast milk and the fact that both me and baby are of same blood group, the level drop from 361 on admission date on to 273 in 43 hours.

Also a big thank you to all the doctors, nurses and staffs at HUKM for saving my baby's life!!

In addition, upon discharge, HUKM recommended a follow up audio test because high jaundice besides affecting the brain could also damage a baby hearing. Will blog on this experience in the future.

UPDATES:- click audio-test-for-baby to know more about this test.

* * * * * * * * * * * * * *

So what have I learnt:-

1) Always know which hospitals are the nearest to you and which have the best emergency service.

Knowing your options will save you time.

- - - - - - - - - - - - - -

2) If you decide to go to emergency government hospital, never ask for referral letters from other hospitals.

Having letters gave the impression that government hospitals are your last minute options. You only went to them because the private hospital rejected you or do not have the facility to treat you.

If you just go there with any medical emergency, like for my case, baby high jaundice, you have better chance of being accepted without any letters.

That is because throughout the conversation between the medical officer (MO) and the pediatric doctor in HUKM on the phone, I kept hearing the MO saying that we went to KPJ (which is govt staff lingo for private hospital) and they did not accept our case for a good 3 minutes before the doctor on the other end rejected us by saying there is no bed available.

This is my personal opinion because I feel that if they are really full, they would have rejected us outright instead of having that long conversation.

- - - - - - - - - - - - - - - -

3) Referral letters cost money $$. My bill at the pediatric was RM70 and RM102.15 at Pantai Ampang.

RM102.15 for medical advice only. There were no medical tests done at all except taking of body temperature. I suspect the amount is for the referral letter which is now in HUKM's record.

RM70 bill from the pediatric

RM102.15 bill from Pantai Ampang