Jaundice in Newborns Should not be Ignored
By Srisatish Devapatla, MD, FAAP
Jaundice is a very common condition
in newborn babies. More than 50 percent of babies develop jaundice and it often
resolves on its own. However, when jaundice does not resolve quickly it is
critical for parents to take steps to treat it because a sustained level of
jaundice can be quite detrimental to the baby.
What exactly is jaundice?
Jaundice is yellowish discoloration
of the skin and mucous membranes due to a pigment called bilirubin. This
pigment is released from red blood cells when they break down. When babies are
born they have a higher red blood cell count than healthy adults, and the red
blood cells of babies live only three months, as compared to four months in an
adult. The result, for a newborn baby, is an overload of bilirubin coupled with
an immature liver that can’t work fast enough to process this excess bilirubin.
This increased load of bilirubin stains the skin yellowish-orange.
What should parents of newborns
expect as the normal course of events?
In a full-term baby, the bilirubin
rises steadily from the time of birth, peaks at about four days, and then drops
back down. In babies born prematurely, the bilirubin peaks in five or six days,
and then drops down. Because the majority of full-term
newborns leave the hospital setting before their jaundice peaks and
begins to drop down, it is important that parents know to look for signs of
jaundice and stay in close contact with their pediatricians. Premature infants
stay in the hospital a little longer so their jaundice is typically treated
before they are discharged.
What should parents look for as
signs of jaundice?
View your baby naked in natural
light. Look for yellow skin and yellow staining of the whites of the eyes.
Apply gentle pressure with your thumb to the skin on the baby’s forehead: if
you see yellow discoloration when you remove your thumb, your baby has
jaundice. Jaundice spreads from head to toe. Bilirubin levels are high if hands
and feet are yellow stained.
Other signs of jaundice include
decreased activity of the baby, poor feeding, dry lips, and a decreased number
of diapers. These are all signs of dehydration, which is one of the
characteristics of jaundice.
Why is it dangerous to leave jaundice
While most jaundice in newborns is
harmless, an inappropriately high level of bilirubin affects the brain
temporarily. Left untreated, a sustained level of high bilirubin can cause
permanent brain damage, deafness, seizures, and an unusual form of cerebral
palsy. This type of permanent brain damage is called kernicterus.
What is the recommended follow-up
once the newborn leaves the hospital?
Your baby should be seen by the
medical care provider between three to five days of life. The exact timing will
vary based on your circumstances.
If you have had a home-birth or
very early discharge from a hospital birth, and you
notice signs of jaundice in the first 24 hours after birth,
this is not normal and you should call a doctor immediately.
How is jaundice treated if it
In the follow-up visit, the medical
care provider will check the baby’s weight and talk with parents about the
adequacy of breast milk intake and voiding and stool patterns. The doctor may
also check the serum bilirubin level. Sometimes this is done by heel-prick
blood test or by using a noninvasive probe on the surface of the skin. This
probe, which is called a transcutaneous biliometer, is used at Cayuga Medical
Center and makes a needle-stick unnecessary in many cases. If the bilirubin is
high, the baby will be treated with phototherapy, also called light therapy. In
rare cases of serious jaundice, the doctor may recommend an exchange of blood,
which requires a blood transfusion.
Are there other types of jaundice?
Yes, there are other types of
jaundice in newborns and these conditions need to be addressed.
jaundice, which occurs during the first week of life, is due to dehydration
in the baby because the mother is not producing enough milk. This is treated by
more frequent breastfeeding, supplemented with feedings of formula, not water
jaundice, which occurs after the first week of life, is caused when
substances in the breast milk cause bilirubin in the baby’s intestines to be
reabsorbed by the body. Treatment requires a mother to stop breastfeeding for
two days while the bilirubin is monitored, during which time the baby consumes
formula. Mothers continue to pump breast milk during this time, until they
resume normal feeding. Breastfeeding should never be permanently discontinued
due to breast-milk jaundice.
Devapatla is a pediatrician who is board certified in neonatal-perinatal
medicine. He is the medical director of the Level 2 Special Care Nursery at Cayuga
Medical Center. He completed his pediatric residency at Metropolitan Hospital
Center, New York Medical College, and did his fellowship training in
neonatal-perinatal medicine at MetroHealth Medical Center, Case Western Reserve