Jaundice in Newborns
Should not be Ignored
Special to the Journal 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
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
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
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 untreated?
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 doesn’t resolve?
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 or sugar-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.
Dr. 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 University.