1. Jaundice Pertinent facts: – What happened: Onset of jaundice that progressed the next day. – Test done: Serum bilirubin determination – Result: Bilirubin level of 12 mg/dL – Treatment done: Phototherapy

2. Differentials of Jaundice Breastmilk Jaundice – Immediately ruled out due to time of onset Physiologic Jaundice – Inconsistencies: The PEAK rise of bilirubin levels in physiologic jaundice, should not exceed 5 mg/dL/day PEAK of bilirubin level is less than 13 mg/dL – At onset, bilirubin of the baby is at at 12 mg/dL.

3. Diagnosis Breast feeding Jaundice / “Lack of breastfeeding” jaundice – Caused by insufficient breast milk intake – Infants born by cesarean section are at a higher risk – Baby is under parenteral nutrition What was fed (glucose water) might have caused hyperbilirubinemia – Onset was on the 1 st Week of Life

4. Phototherapy: Beneficial or Not? The baby is still under mechanical ventilation and unable to breastfeed In phototherapy, bilirubin in the skin absorbs light energy, causing several photochemical reactions which would allow unconjugated bilirubin to be excreted in the bile without conjugation Conclusion: baby should be treated with phototherapy until such a time that he can be breastfed properly.

5. Food Intolerance On the 48 th Hour of Life – Action done: Minimal enteral feeding was started with 2 mls of expressed breastmilk every 3 hours – What happened: Abdomen became distended – Response: Feeding was stopped On the 72 nd Hour of Life – What happened: He was successfully taken off the ventilator and extubated – Actions done: Feeding was resumed with 2 mls of expressed breastmilk every 2 hours. – Response: Feeding was tolerated well. Further Action: Feeds were gradually increased over the next 3 days until he was able to tolerate 20 mls every 3 hours.

6. Food Intolerance Considered a complication in enteral feeding Baby is preterm and its digestive system might not have been yet fully developed The feeding was stopped and resumed a day later – now tolerated.

7. Stakeholders Psychosocial and Economical Impact

8. Father Little to No Influence Second to the mother, he is perhaps the most affected Feelings of guilt Feelings of helplessness Added burden of responsibility Economically, it has little impact on him as of now

9. Siblings Competition for resources Feelings of Envy Feelings of protectiveness

10. Hospital Healthcare Team Impact on Reputation impacts financial standing – If Baby dies Bad reputation -> Less patients -> Less income – If Baby gets well Good reputation -> More patients -> More Income