What is Newborn Jaundice?
Jaundice is a word to describe a yellosih color of the skin or the whites of the eyes.Approximately 50-60 percent of all normal birth, full-term infants develop jaundice during the first week of their life.And, about 80 percent of all premature infants develop jaundice.Jaundice is fairly common and is usually completely harmless in many newborninfants.Jaundice is not a disease but a condition.All during a person's life new blood cells are being created and the old ones are being destroyed.Parts of the old cells are broken downand an oxygen-carrying substance called hemoglobin is changed to bilirubin.
Bilirubin (pronounced "billy reuben") is a yellow colored substance.This bilirubin is normally removed by the liver but in the cases of many normal newborns their liver is not mature enough to get rid of the bilirubin.Therefore, a build-up results in the blood stream.It is this bilirubin build-up that causes the skin and whites of the eyes to become yellow.
Most infants with jaundice have no other symptoms. They are alert,eat and sleep normally. However, a parent should call the infant's health care provider immediately or seek emergency medical care if the infant develops increased sleepiness,is hard to wake, sucks or nurses poorly, appears weak or floppy, arches the neck or back backwards, or develops a high-pitched cry or fever.These may be early warning signs of dangerously high levels of bilirubin that require prompt treatment to prevent a rare form of brain damage called kernicterus.
Will my baby be checked, and how?
While a newborn is still in the hospital the nurse, doctor or midwife will observehim for signs of jaundice.If it appears thathe is developing jaundice or evenis at an increased risk for jaundice thenthe infant's health care provider may measure the level of bilirubin with a skin test or a blood test. The blood test is the most accurate way to determine the severity of jaundice. One of these tests also may be recommended for some babies with darker skin because it may be difficult to tell if a baby has jaundice by examining the skin.Â
After a new parent takes an infant home signs for jaundice should still be monitored.Parents can watch for an increase in yellow color of the skin or the whites of eyes.Normally, jaundice starts showing in the face first and then spreads down throughout the rest of the body, mainly to the stomach and legs.The yellow tint may also be harder to discern depending on the infant's natural skin coloring.The more areas of an infant's body that are colored yellow, the higher that bilirubin levels are.Infants should be examined again by a health care provider at three to five days of age because this is the time when bilirubin levels are highest.A parent can look for the yellow in natural light or under flourescent lights.
When does Jaundice typically occur in infants?
Some infants are jaundiced at birth but others develop it later.Jaundice which appears at birth or within the first twenty-four hours of life may be the result of a number of problems and may be more serious.Such as, if an infant is bruised at birth they may be at an increases risk of developing higher bilirubin levels and therefore jaundice.There may also be more serious conditions, such as liver failure or complications, that are the cause of the jaundice.Situations such as these may prove to be more life threatening or health degenerating.However, most infants who develop jaundice do so within the second or even the third day of life and are at a less risk for more serious complications later on.
Other types of Jaundice
One condition, called ABO incompatibility, occurs when the mother of the infant has a different blood type than the newborn.When a mother who has type "O" blood gives birth to an infant who has type "A", type "B" or type "AB" blood he is at a high risk of being exposed to the mother's blood type.When this situation occurs, the infant's body tries to fight off the blood that does not belong to him, this being the type "O" blood.Then the infant's body has to get rid of this other blood.This increases the amount of bilirubin the infant's liver has to take care of, thus causing an increase in bilirubin levels.Â
Another type of jaundice that can have more serious complicationsoccurs when the mother has an Rh-negative blood and the baby hasRh-positive blood.The events which happen here are similiar to what happens with the ABOincompatibility jaundice.Â
There are other, more rare, causes of jaundice but the older an infant is (measured in hours) the better that infant has of combating jaundice without treatment.However, treatment may be necessary in some cases.
Who is more likely to develop Newborn Jaundice: Breast or bottle-fed infants?
Breastfedinfants are more likely than formula-fed infants to develop jaundice.However, severe jaundice occurs mainly in babies who are not nursing well becausethey may not get enough caloriesorbecome dehydrated, both of which may contribute to severe jaundice. Breastfeeding mothers should nurse their babies at least eight to 12 times a day for the first several days of life to help keep their baby's bilirubin level down.It is alo very important to ensure that the infant has a good suction on the breast and that he is actually getting milk.It is often hard to tell how much an infant is actually drinking, or if they are just suckling without receiving any milk.
Mostinfants with jaundice do not need treatment.But infants who require treatmentare usually started on what is known as "phototherapy."This is a treatment which exposes the infant to a "special-superblue" light.This light helps speed up the removal of bilirubin from the blood by the liver.During this phototherapy the infant is undressed so that most of the skin is exposed to these blue lights.Theinfant is placed naked (or wearing only a small diaper) under special white or blue lights called bili-lights.Eye patches will be used to protect the infant's eyes.Throughout the procedure their temperature will also be monitored.Â
The bili-lights help change bilirubin in the blood to a form that can be easily eliminated in urine.The infant remains under the phototherapy blue lights until the bilirubin levels stop increasing and appear to decrease to safer levels.Some infants may need to stay for anextended amount of time in the hospitaluntil their bilirubin levels decrease even after the phototherapy has stopped.A health care providermay ask a parent to bring the infant back to the hospital to check the bilirubin levels in one to two days depending on the circumstances.Someinfants are delayed in discharge from the newborn nursery or are admitted to the hospital for a few days for phototherapy, while others are treated at home.Special fiber-optic blankets also can be used to treat some infants.An infant'shealth care provider can discuss with the parents which treatment is appropriate for their child.
Sometimes while under the phototherapy lights an infant may havean increase in the number of greenish colored stools (bowel movements) that he has.This is normal and not a cause for concern.After the phototherapy treatment this discoloration of the stool usually stops as well.Some infants may alsodevelop a mild skin rash that goes away when treatment is completed.Â
Health care providers sometimes suggest steps parents can take at home to help clear up mild to moderate jaundice. In addition to, or maybe instead of, the phototherapy treatmentsbreastfeeding support may be needed toincrease bilirubin elimination through the abdomen. The provider may also recommend increasing the number of feedings to encourage more bowel movements, which helps eliminate bilirubin. However, a health care provider may suggest the opposite.For some breastfed babies, it is recommended thatbreastfeeding is stopped briefly (one to two days) and formula is used in for feeding.
While phototherapy is effective, a few babies may not respond and continue to have rising or dangerously high bilirubin levels. They may need to be treated with an exchange transfusion. In this procedure, the baby's blood is removed little by little and replaced with donor blood. Exchange transfusion is effective at lowering bilirubin levels. However, it can pose a risk of infection and other complications, so it is recommended only when bilirubin levels are very high. It is best done in a neonatal intensive care unit.Â
Who is at an increased risk for Newborn Jaundice?
Some infants are at a higher risk for jaundice when certain conditions are evident.These conditions might include, but are not limited to:infants whohave high bilirubin levels before leaving the hospital; infants with signs of jaundice in the first 24 hours of life; premature babies (born prior to 37 weeks of pregnancy); babies who had a sibling who was treated for jaundice; babies of East Asian descent; breastfed babies, especially those who are not nursing well; babies with large bruises or a cephalohematoma (bleeding under the scalp related to labor and delivery); for a family history of a genetic disorder called G6PD deficiency.
Things a parent/caregiver can do
Infants with jaundice need extra fluids.An infant'shealth care providermay ask that an infant with jaundice be fed every 2-3 hours regardless of what that infant's usual feeding times are.This is important to maintain in order to speed up the recovery process.Â
Indirect sunlight can also help aid in the recovery process.When at home, a parent or caregiver can expose an infant's skin tp sunshine by laying them near a window.This gives them the benefit of the sunlight without the damages caused by placing them directly in the sunlight, such as outdoors.An infant's skin is delicate so it is important to use indirect sunlight or an infant will be at risk for sunburn, heat stroke or heat exhaustion.
Keep monitoring the yellowish coloring.If it continues to increase, such as to the palm's of his hands or the whites of his eyes, call the infant's doctor immediately.
And, remember, if an infant has jaundice the best source of information and advie is from the infant's pediatrician or the family doctor.They can answer any questions a parent or caregiver may have about the infant's condition or treatment.