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All You Want To Know About Neonatal Jaundice But Afraid To Ask

April 6th, 2014 · No Comments ·
 
 

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When we brought our first baby back home from the hospital, we found our baby face looks bit yellow.  So, we brought her to see paediatrician.  Fortunately, doctor assured us she was fine.  After a week, the yellow color went away.  It is something what we call jaundice.  Jaundice is the yellowish discoloration of the skin or white part of the eyes.  Neonatal jaundice is jaundice that occurs within the first month of baby and 50% of babies have jaundice.  It can occur in babies of any race or color.

Why The Skin Appear Yellow?
When red blood cells are broken down, whether adult or infant, bilirubin is formed and released into the bloodstream.  Bilirubin is a yellowish-red pigment.  So, the yellowish coloration is caused by an excess amount of bilirubin in the baby’s skin.  The bilirubin dissolve into the top layer of fat under the skin, causing it to turn yellow.  Normally, small amounts of bilirubin are found in everyone’s blood, including adult. When too much bilirubin is made, the excess goes into the bloodstream and is deposited in tissues for temporary storage.

But, Why Baby?
Newborns have a high red blood cell volume.  When they are broken down, the bilirubin is then carried to the liver where it is processed and eventually passed out into the stools.  However, newborn’s liver is immature and is not able to process bilirubin fast enough.  This slow processing of bilirubin has nothing to do with liver disease.  Because of this delay, this bilirubin causes the skin to have yellowish color.  Jaundice normally appears first in the face and upper body.  It then progresses downward toward the toes.

How Many Types of Neonatal Jaundice?

  1. Normal jaundice (physiological):  This jaundice occurs in most newborns due to the immaturity of the baby’s liver, which leads to a slow processing of bilirubin.  It appears at 2 to 4 days of age and disappears after 1 to 2 weeks.
  2. Jaundice of prematurity: Jaundice occurs frequently in premature babies since they are even less ready to excrete bilirubin effectively.
  3. Breast milk jaundice: In rare case, 1% to 2% of breastfed babies, jaundice may be caused by substances produced in their mother’s breast milk that can cause the bilirubin level to rise. This change may prevent the excretion of bilirubin through the intestines. It starts after the first 3 to 5 days and slowly improves over 3 to 12 weeks.
  4. Blood group incompatibility (Rh or ABO problems): If a baby has a different blood type than the mother, the mother may produce antibodies that destroy the infant’s red blood cells. This creates a sudden buildup of bilirubin in the baby’s blood. Rh problems once caused the most severe form of jaundice, but now it can be prevented with an injection of Rh immune globulin to the mother within 72 hours after delivery, which prevents her from forming antibodies that might endanger any subsequent babies.

What Is The Chance Of Baby Having Jaundice?
Some babies have higher risk of serious jaundice:

  • The baby is born before 37 completed weeks of pregnancy
  • Baby with skin appearing to be yellowish even in the first 24 hours of life
  • Baby with siblings having severe neonatal jaundice
    Baby who has pale colored stools or dark urine
  • Baby who is not breastfed satisfactorily.  Babies may not get enough calories and water, both of which may contribute to jaundice
  • Baby with East Asian descent

What Happens If You Do Not Treat Severe Jaundice?
If bilirubin reaches a toxic level, it may cause deafness from damage to the part of the brain controlling hearing.

When To Call Doctor?
You should see the doctor immediately if:

  • Jaundice is noted during the first 24 hours of life
  • Baby is having fever over 37.8° C (100 ° F) rectally
  • Baby is not feeding well and the yellow color of skin and eyes deepens

How To Prevent Jaundice?
Nursing mother should breastfeed her baby 8 to 12 times a day for the first few days to encourage more bowel movements and therefore help keep the bilirubin level down.  If frequent feedings is not possible, you may want to feed your baby with formula as supplement.  Feed the baby more water to help decrease the bilirubin levels.  Do not give up on breast milk though because it is still the ideal food for your baby.  Continue to feed her once the bilirubin level is down.

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Some mothers believe that by avoiding yellowish food or fruit during pregnancy, jaundice can be prevented.  It is just a myth.

How To Treat Jaundice?

Two common ways to bring down the bilirubin levels to avoid toxicity:

  • Phototherapy – Baby, wearing only a small diaper, will be put under a phototherapy light unit.  The baby wears shields to protect the eyes. The blue colored light convert the indirect bilirubin to a non-toxic product which can be easily eliminated in urine.  Phototherapy is safe.  Some babies develop mild skin rash which will go away when treatment is completed.

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  • Exchange Transfusion – This method is used as a last resort for baby who does not respond to phototherapy and continue to have rising bilirubin levels.  Baby’s blood is removed little by little and replaced with donor’s blood.  This method may pose risk of infection and other complications and therefore it is done in a newborn intensive care unit.

How about putting baby under sunlight? I do not recommend it even though exposing your baby to sunlight might help lower the bilirubin level.  This method only work if the baby is completely undressed.  Your baby will get cold because of lower antibody.  Furthermore, newborns should never be put in direct sunlight outside because they might get sunburned.  The darker color of the skin not necessarily indicates the jaundice has gone away though the skin appears dark and not yellowish.

Hopefully, after reading this post, as a parent, you will know what to do if you suspect your baby is jaundiced.

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Category: Health


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