HC_chronicles of event 4:Cephalohaematoma

7 hours after birth, after the follow up paed MO review, HC was found to have a cephalohaematoma on the left side of his head, likely as a result from the vacuum intervention. According to the review, Dr mentioned it was the size of 1 x 2 cm, and should resolve within a day or 2. So its shouldn't be a big deal.

The affected part of the head was squishy to touch and I had to be even more gentle in handling him especially while trying to position him for breastfeeding. 

However, on day 4 of life, when he was admitted for phototherapy due to jaundice, the same Dr was doing round in NICU, she sounded surprise upon examining him and wonder why the cephalo had became bigger to 3x4cm. She even sound blaming me for not monitoring him properly for jaundice, like "how come now only bring baby here...how come didn't call Klinik Kesihatan to have nurses visit...." which add guilt to my not so good start after birth experience. I became more worried, such thing grew bigger always sound bad, especially previously I had handled a case with infected cephalo, I hope and prayed that it won't happen to HC.

After we were discharged home and as HC underwent home phototherapy, I felt so guilty so much so I couldn't sleep well. I blamed myself for not being able to exert all my effort to push him out till requiring vacuum intervention, I felt useless, I should have gone to hospital earlier, should have asked for better position for pushing ( as I recalled I was not in ideal position or posture in delivery), I shouldn't be bothered by the tearing of tissue....I felt so sorry that I made HC having to go through all these....poor HC, its mummy's fault.

My worries and concern deepen as I suddenly felt something squishy on the right side of HC head too! That was something new! How come Dr didn't detect it while he was in NICU? They kept mention cephalo on the left. Was the cephalo spreading? I googled somemore, and more and more worried as I read the possibility of  brain damage, infection and neurosurgery intervention. No, no, please, this would be very traumatic to HC and me!

Thank God that I have friends who are Paediatrician. I whatsapp them for opinion and took the below picture

I was reassured by my friend that the right one 'surface' later as the head swelling during birth reduced, as both cephalo were separated and not crossing the suture line, so the situation was still ok and I should continue to monitor the size. Monitoring....that's really testing my patience. Everyday, I prayed hard that the cephalo size won't increase somemore. I prayed, that should the size not reduce, be it due to calcification, at least please dont let them increase somemore. Everyday, I kept softly touching and trying to measure using my fingers.

3 days after earlier picture

I had to really thank God that the Cephalo indeed not increasing. Finally before the second admission on day 26 of life, or by third week, they had resolved completely, though the one on the right seemed to have calcified as I still could see the 'bump'. Nevermind, at least they had resolved. 

So, first concern at the first week: G6PDd and Jaundice ---pending resolving

      Second concern/scare at the second week: Cephalohaematoma ---- Resolved

      Still there was a third scare.... sigh..... at next post

HC_chronicles of event 3:Home Phototherapy

Next day, we go to Dr Koe's clinic. As usual, the wait is really long, think for 2 hours, just to take the blood sample. Later in the afternoon, I am informed that the level has gone up to as high as 276.6umol/L, ie indicated for phototherapy again. Dr Koe recommend to start the home phototherapy instead, hence she contact bluelite company. For 3 days therapy, it cost about RM445, our is RM475 due to confirmation of service after office hour. Around 9pm, the unit is set up on top on the cot. As I can't subject to fan yet and need to on aircond, we put mattress and sarong surrounding the area so that he wont get too cold. We have to set the aircond temerature to 26-27 degree celcius too, which is actually still hot to me. 

HC dont like the eye shield, in fact he scream upon touching it! Hence we have to resort to using head shield instead. However, I can't really well but having to check on him from time to time as HC is able to knock the shield with his hand and the light could harm his eyes. Another challenge is to let him able to sleep inside the kit, I have to feed him, put down, if he can't settle, then repeat again and again. Its indeed tiring

Next day, we go to Dr Koe clinic to repeat blood test again. The bilirubin count is 268umol/L only reduce a bit. Hence for the next 3 days, HC sleep inside the kit. Indeed, this is much better than having to stay in hospital and I can have more rest with confinement lady and mom in law help.
After 3 days, the bilirubin has dropped to 243.9umol/L, as its still not low enough, and its likely due to the cephalohaematoma. Hence Dr Koe ask to continue for further 3-4 days till HC is 14 days old. When we go back to the clinic, Dr Koe review and dont see HC need another blood test and dont need to cont the home phototherapy anymore. Despite the positive review, I still have my concern and worry that it will rebound

HC_chronicles of event 2: Jaundice

Right after birth, HC has been passing out the meconium very well. However, on the day we are discharged home, he hasn't passed a motion, and to my worry, not even a pee too.  At night ( near to 72 hrs post birth), then he pass a small amount concentrated urine. I am worried but I dont want to too alarm myself, we are just back from hospital, please dont tell me to go clinic for blood test for bilirubin. Oh the next day, again HC    dont pass any urine nor motion. He is also getting more yellowish. at night, the disposable diaper is stained with pink powder ( initially we are scare that its blood).
26March, as he is getting more yellowish till even palm, I got to bring him to see Dr Koe.  In the afternoon bilirubin test found 323 umol/L, and Dr Koe advice to go to hospital to be admitted. Thank God that my colleague is working in NICU and she help me arrange everything. As HC is G6PDD and the bilirubin count is high, intensive phototherapy is prescribed and HC has to be put into in a spaceship like device. The same MO come to examine him and even ask to start IV drip at 75ml/kg/day, she also ask me to stop breastfeeding temporarily. I am devastated especially thinking that HC need to be put in branula for IV drip.
The doctor instruction for witholding breastfeeding has indeed discouraged me and I just walk out of NICU to have my dinner brought by husband. Then I just serve the net instead trying to calm myself.
Later hubby call me and say HC cry nonstop, I am just devastated and refuse to go back to NICU, since I am asked to withold breastfeeding :" what can I do? let him be.." Finally I go back to the ward, then the nurse in-charged ( SN Su) ask me :" Are you sure you dont want to breastfeed?", "Tapi doktor minta saya berhenti, saya ingat saya pump saja," I reply, "pasti ke, sayangla kalau you nak berhenti....". I am like encouraged "saya cuba la". From my eldest experience, she can hardly get off my breast when she is just a few days old, I am not confident as I know HC need to be under the photo and breastfeeding time can interrupt it. So I just feed and feed, apply breast compression as much as possible, left and right and left... then finally he slept soundly and able to stay inside the spaceship like phototherapy machine.

Then 1 hour later, the doctors do round and has to examine HC ( This is the part I dont like, I put so much effort trying to put HC to sleep, once the doctor do round, HC wake up and I have to repeat the cycle again...). However, during midnight, either its due to the dextrose drip, or HC is too tired, he sleep for 4 hours straight, even after doctors take several blood samples! In order to let him have as much phototherapy as possible, I don't even want to clean his buttock knowing he has passed motion.

Finally in the morning, the bilirubin has drop further , from 332---285---209---182. Finally no photo is required and I am so relieved that I can just hold him. HC is such a dear, and he sleeps after I feed both sides though it takes around 1 hour long, but I am able to refresh myself, go toilet, have lunch and dinner at ease. At night we are discharged home. However, I feel myself neck pain and back pain, I can't even walk easily, feel like something is in between my vagina, sometimes I feel sudden sharp pain which make me walk real slow

HC after intensive phototherapy

Though discharge home already, we still need to check the bilirubin level again next day

Baby #3_HC chronicle of events 1

Just a short note at the end of my confinement.

On 22nd March 2013, 1152pm, my little baby boy HC is born. It is an eventful birth which need to be described in details in another post. Just as I want to enjoy this new birth, it has overlap with lots of worries and concern.
23rd March, as early as 6am, 2 paed MOs come in to check on HC. Then its the first time I hear about cephalohaematoma and hydrocele. However, they assure me that the cephalohaematoma is only 1x2cm and should be resolved within a day or 2. The hydrocele also is not uncommon and likely resolve by itself within a week. Later Paed specialist check HC again, she say HC likely will have jaundice due to the haematoma. ( Oh no, Jaundice....something I wish not to experience again :(...)
Later  I thought I can be discharged home after my gymae come to to check, nurse came in to inform that HC found to be  G6PD deficient. I know what it is as my younger brother has it too and its implication but I can't help to be worried as it mean HC need to avoid some materials and medicines. Things like Napthalene (moth ball) and Minyak kapak angin are so commonly used, I am concerned what if people taking care of him not aware and end up HC suffer haemolysis which can be life threathening.

24th March, I can tell that HC is getting more yellowish. The paed specialist visit again and say HC likely need to stay in hospital for 5 more days for observation as G6PDD likely will have jaundice. Hence blood test is taken to check the level of G6PDD and also the bilirubin level. As expected, the bilirubin level is 150umol/L, however the paed specialist allow HC to go for home monitoring and to come back if tea colour urine is observed. Finally, both mother and child can be discharged home. However, I become busier since then....