Jaundice is a common problem in newborns-one that is responsible for a lot of office visits and hospitalizations in the first few days after birth. Infant jaundice is a yellow discoloration in a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow-colored pigment of red blood cells. Infant jaundice is a common, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breastfed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream.
What Is All the Fuss About?
Bilirubin is a waste product formed when red blood cells are cycled-a process that happens continuously in all of our bodies. Under most circumstance, bilirubin is processed in the liver into a form that can be eliminated in the stool and urine. Prior to birth, bilirubin simply crosses over the placenta into the mother’s blood stream to be processed by her liver. And after a baby is born there are reasons that this process may not work as it should.
Reasons for Jaundice
- The baby’s liver never had to process bilirubin, the enzyme responsible for this task isn’t very active. After birth it can take a few days for the liver to adjust. This is not harmful at all.
- Not-Feeding Jaundice – When an infant is born, it may take up to a few days for the mother’s milk to come in. And because bilirubin is eliminated in the stool and urine, the more an infant eats, the faster it goes away. This problem is uncommon in formula fed infants simply because there is no delay in feeding after birth.
- Breast Milk Jaundice – We think this is due to a substance in breast milk that causes the baby to reabsorb some of the already processed bilirubin from the intestine.
- Compatibility between the mother’s and the infant’s blood types. In these cases, we check the antibodies and watch the baby’s blood counts and bilirubin more closely. If intensive phototherapy in the hospital doesn’t bring the bilirubin level down quickly enough, the baby may need a special blood transfusion in a newborn intensive care unit. Fortunately, this is very rare.
- Some people have red blood cells that brake down faster, so the liver has more work to do
- Premature or very sick infants often have significant problems with jaundice.
- Obstruction in the Liver can prevent the processed bilirubin from being transferred to the intestine.
When is Jaundice Concerning?
The reason we care about Jaundice is that just like bilirubin is deposited in the skin, it is deposited in other tissues as well, most notably, the brain. Kernicterus is a very rare type of brain damage that occurs in a newborn with severe jaundice. It happens when a substance in the blood, called bilirubin, builds up to very high levels and spreads into the brain tissues. This can cause permanent brain damage. This is extremely rare in developed countries and is almost always preventable just by monitoring bilirubin levels in babies.
How Babies Are Checked for Bilirubin Levels
Years ago pediatrician just tried to estimate an infant’s bilirubin level by their color. Eventually, we figured out we were not very good at it. So now we check bilirubin level in all infants before they go home from the hospital. This can be done as a blood test taken from a heel stick or using an instrument that analyzes the color of the baby’s skin after that test if the color level is high a blood test is needed.
Help for Breastfeeding Mothers
Jaundice is more common in breastfed babies and tends to last a bit longer. Appropriate lactation support and frequent nursing helps to minimize any problems. In some cases, it is necessary to supplement with formula while the mother and mother and infant continue to work on breastfeeding. Rule number one is feed the baby. Sometimes if that is not enough phototherapy is necessary. This is a light that emits photons of a specific wave length. This is call photo isomerization. Medical definition of photo isomerization: the light-initiated process of change from one isomeric form of a compound, radical, or ion to another. This process makes jaundice better.
The Use of Phototherapy
The effect of light on jaundice in neonates, and the ability of light to decrease serum bilirubin levels, was first described by Cremer et al in 1958. This observation led to the development of light sources for use in the treatment of infants with hyperbilirubinemia, a treatment now referred to as phototherapy. Since its inception, phototherapy has been effectively used as a relatively inexpensive and noninvasive method of treating neonatal hyperbilirubinemia. The decline in the number or exchange transfusions in recent years is, at least in part, likely a direct reflection of the effectiveness of phototherapy at treating hyperbilirubinemia.
The good news is it is extremely uncommon for infants to have any long term problems from jaundice.
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About Pediatrics of Florence
We believe that children are more than just “little adults.” They have unique personalities, challenges, and life circumstances and we have made every effort to make our offices and care as “kid friendly” as possible. We have an aquatic theme in the waiting rooms (separated for sick and well children) as well as themed examination rooms. All of our physicians are Board Certified Pediatricians and members of the American Academy of Pediatrics and our nurse practitioners are all licensed Pediatric Nurse Practitioners and are available to see both well and sick children.
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