Almost every parent has heard that their baby has jaundice and that is because almost every baby has some degree of jaundice after birth.
What is newborn jaundice?
The first thing we have to cover is what newborn jaundice is. Jaundice is when a baby has an increased level of bilirubin in her blood. Bilirubin is a yellow substance that the body creates when it replaces red blood cells and is filtered through the liver and removed from the body through stool. The increased level of bilirubin gives the baby’s skin and whites of her eyes a yellow tint; the tint will become more pronounced as the levels increase.
What causes newborn jaundice?
Almost every baby has some degree of jaundice. When the baby is in the womb, the placenta removes the bilirubin from the fetus’ blood, but once the baby is born, the liver has to start doing this. It can take some time for the liver to take over it’s new role, and thus almost every baby has some degree of jaundice, known as physiological jaundice, most notable at 2-4 days of age and usually goes away within 2 weeks with no problems.
There are also a couple of types of jaundice that can happen in breastfed babies. The first is breastfeeding jaundice which is seen in the first week of life when the baby doesn’t nurse well or mom’s milk is slow to come in. The second type is breast milk jaundice, that occurs after 7 days of life and most likely peaks at 2-3 weeks of life and can continue with low levels of bilirubin in the blood for up to a month. This is thought to be caused by how substances in the breast milk affect how the liver breaks down bilirubin. Both of these should be monitored, but neither one should cause any major issues.
Newborn jaundice occurs when there are large numbers of red blood cells that have to be replaced. For example, this can occur if the baby has abnormally shaped red blood cells, blood type incompatibility between mother and baby’s blood, bleeding under the scalp or other bruising caused by a difficult delivery, infection, or higher levels of red blood cells such as occurs with twins or small for gestational age babies. There are also things that make it harder for the baby’s liver to remove the bilirubin, for example, some medications, infections, conditions that affect the liver, low oxygen levels, or other genetic and inherited conditions. Premature babies are also more likely to develop high levels of bilirubin.
What are the symptoms of newborn jaundice?
There are not many symptoms of jaundice, but there are a few that are pronounced. The most obvious is the yellowing of the skin. As the jaundice worsens the sclera, or whites of the eyes, will turn yellow. Infants with jaundice will also appear to be very sleepy and difficult to wake up. They will also feed poorly.
How do I know if my baby’s jaundice requires treatment?
There are many tests that your doctor will do to determine the exact cause and level of bilirubin in your baby’s blood.
To start, most hospitals will obtain a transcutaneous reading, or a reading just by placing a device on the skin. This does not give an accurate measurement, but will give them a range and help determine if further testing is needed.
If it is determined that your baby does need further testing, a blood sample will be obtained to determine the exact level of bilirubin. This can be done with a heel stick or a venous blood sample.
If the level is high enough your baby will need to be treated, if it is not too high your baby will just be monitored.
If your baby continues to have increased bilirubin levels further testing will need to be done to determine the cause.
How is jaundice treated?
The good thing is that jaundice is easily treated. Most of the time nothing needs to be done. Some babies need treated before leaving the hospital and others may be able to come home for a day or two first.
If your baby gets to go home and you know they are watching her bilirubin levels, there are several things you can do at home to help prevent her from being admitted to the hospital again.
The most important thing is to make sure your baby is well hydrated. If you are formula feeding, make sure your baby is eating every 3 hours, even through the night. If you are breastfeeding, try to feed your baby 10-12 times per day. An easy way to tell if your baby is hydrated is if she is peeing and pooping. If she is not wetting at least 5-6 diapers per day by the time she is 4 days old, you may need to increase her feedings. You may also have to wake your baby up to feed if she is particularly sleepy. If you are breastfeeding, there is no need to supplement with formula and you should talk to your doctor before doing so.
Another thing you can do is put our baby in front of a picture window in only her diaper during the day. The sunlight helps her body break down the bilirubin. This is similar to what they will do in the hospital, except they will use special blue lights. If you are worried about your baby getting cold you can turn up the heat in your house, but usually babies will be fine.
If the levels are high enough that your baby has to stay in the hospital there are a couple of things that will happen.
As at home, the most important thing is to keep your baby hydrated. They will monitor how much she is eating, peeing, and pooping. In rare cases, if it is thought that your baby is dehydrated, she may be placed on an IV to help hydrate her.
The biggest thing that will happen in the hospital is your baby will be put under blue lights, also called phototherapy lights. She will most likely also have a light under her. She will be stripped down to her diaper and placed under the light. She will also have a protective eye cover on. If there is a light under her, she will lay on her back on this. When you pick her up to feed her, you will leave this light under her and wrap her in a blanket.
Most of the time jaundice is not harmful, though a very high level of bilirubin can be harmful and cause brain damage, cerebral palsy, or deafness. Jaundice is usually caught and treated before levels get this high however. Jaundice is also very treatable.
All babies should be seen within 5 days of birth to screen for jaundice. If you suspect your baby is jaundiced, watch for increased severity of symptoms. If your baby seems to be getting yellower, is listless, not feeding well, or has a fever, you should see your doctor or go to the emergency room right away. Jaundice is generally not dangerous for babies born full term with no additional medical conditions.
Did your baby have jaundice? Did they need to be treated or did you treat it at home?