Jaundice
Jaundice is a yellow color of the skin and white of the eye caused by the accumulation of a yellow substance known as bilirubin in the bloodstream. Bilirubin is one of the natural by-products of the breakdown of hemoglobin in red blood cells. Our bodies are constantly breaking down and excreting old-red blood cells and making new ones. Normally this breakdown and excretion process of bilirubin is handled by the liver which removes bilirubin from the bloodstream as it is produced and excretes it via the bile into the stool without any problem and we do not become jaundiced.
At birth your baby has a proportionately higher hemoglobin than he will have by 2-4 months of age. This higher hemoglobin helps the baby get enough oxygen to its tissues while in the uterus where where the placenta delivers oxygen at a much lower concentration than we breathe from room air. The baby may also get extra hemoglobin from the placenta via the umbilical cord until it is cut. Once the baby is breathing the higher oxygen concentration of room air, the baby no longer needs the extra hemoglobin and the baby’s body begins breaking down the extra red blood cells creating a large supply of bilirubin to be excreted. At the same time, the newborn’s liver is relatively immature in its excretory function for bilirubin. This excretory function will increase day by day over the first week or two of life. Consequently, your baby tends to make more bilirubin than his liver can handle in the early days of life. As a result, bilirubin levels build up in the bloodstream giving your baby’s skin, and sometimes eyeballs, a yellowish color. Most jaundice caused by this normal adjustment following birth requires no treatment and is called “physiologic jaundice.” This jaundice reaches its peak in three to five days after birth and then begins to disappear as excretion begins to exceed production.
Another factor that can contribute to your baby’s becoming jaundiced is infrequent feedings. Babies excrete bilirubin naturally in their stools. As a result, babies who are not fed frequently enough do not have as many bowel movements and some of the bilirubin may be reabsorbed into the bloodstream increasing the level of jaundice. To prevent this type of jaundice, nurse your baby a minimum of eight times in 24 hours. If you are bottle-feeding, feed your baby as much as he will comfortably take (2-4 ounces) and as often as he lets you know he is hungry(3-4 hours). Avoid bottles of water or sugar water. These may make your baby feel full so he will not consume the milk he needs. Other factors that may increase the occurrence and severity of jaundice include: prematurity, blood type and Rh group differences between mother and baby and bruising of the skin during delivery.
If your baby looks more yellow after arriving home from the hospital, please call our office so that we can decide if an examination and determination of the bilirubin level are indicated. In some instances, the level of bilirubin can rise to dangerously high levels that can cause brain damage if not treated properly. If you have any doubt about the baby’s level of jaundice, contact our office.
Treatment
Treatment for jaundice varies depending on the cause and the severity. We will discuss in detail the treatment that is best for your baby. In all cases, increasing the amount of milk ingested helps because bilirubin binds with protein in the milk and is then excreted in the stools
Certain wavelengths of the light spectrum change the chemical composition of the bilirubin molecule allowing its excretion via the kidney, thereby bypassing the relatively slow (in the first few days of life) liver excretion. Placing your baby in indirect sunlight may help him increase the rate of excretion of the bilirubin. WE DO NOT RECOMMEND THAT THIS BE DONE. This is not necessary as the bilirubin level will decline on its own as liver function increases over the first week or two of life. Please discuss this with us on a case-by-case basis. NEVER place your baby outdoors in direct sunlight. Babies sunburn very easily! If you do decide to do this, be sure the room is warm (78-80 degrees), undress him to his diaper only and place him in the indirect sunlight coming through a sunny window for 15-20 minutes at a time. Be sure to monitor the baby’s temperature to prevent hypothermia (axillary temperature < 97 degrees F.)
In more severe cases, we may prescribe phototherapy where your baby is placed under special fluorescent lights or a light emitting blanket called a “Wallaby” that help him excrete the bilirubin more quickly. We will discuss this in detail with you if it is necessary. In many instances, the baby will still be able to continue breastfeeding. If this is not thought prudent for a day or two, pumping your breast is recommended to promote and maintain your milk supply.
