Tuesday, April 23, 2024

Newborn jaundice: what parents need to know

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Most newborns turn at least a little yellow. Known as jaundice, this condition is a very common and generally normal part of the neonatal period. But in very rare cases, it can lead to (or be a sign of) a more serious problem. This is why parents should know about it.

What causes jaundice?

The yellow color of jaundice in newborns is caused by high levels of a substance called bilirubin in the blood. Bilirubin mainly comes from the breakdown of red blood cells. It is processed in the liver to make it easier for the body to pass urine and stools.

In order to get rid of bilirubin, the livers of newborns need a little time to be operational. Newborns also have more red blood cells than older children and adults, and these brand new red blood cells don’t last as long as those that form as babies get older. The combination of these two factors is what makes jaundice so common.

Jaundice usually peaks within the first two to five days of life and lasts for about one to two weeks. In breastfed babies, it may last longer; we don’t know exactly why this is happening, but there is nothing to worry about.

Jaundice can actually protect babies, as bilirubin is an antioxidant that can help fight infection in newborns. This is another reason why parents shouldn’t be too worried about a little yellowing: not only is it temporary, but it can also help their baby as he or she leaves the safety of the womb.

Rarely, jaundice can signal a problem

Sometimes, however, jaundice can be a sign of another problem, and when bilirubin levels get very high, it can affect the brain, sometimes permanently. This is very, very rare, affecting far less than 1% of infants.

There are many conditions that can increase the likelihood that bilirubin levels are high, including:

  • Dehydration or insufficient calories. This most often happens when babies are exclusively breastfed and a breastfeeding problem is not recognized.
  • The systems that work to get rid of bilirubin may not be ready yet.
  • Infection or blockage of the intestine. Jaundice would usually not be the only symptom of this.
  • ABO or Rh incompatibility. When mother and baby have differences in their blood types, it can cause red blood cells to break down more than usual. This is something obstetricians are very aware of and tests are done whenever there is a problem.
  • Bruising or cephalohematoma (a lump or bruise on the head). Both can occur during a difficult birth. These lead to the breakdown of more red blood cells.
  • Liver disease. There are a number of different liver problems that can make it harder for a baby’s body to get rid of bilirubin.
  • Diseases that affect an important enzyme. Certain illnesses, like Gilbert’s syndrome or Crigler-Najjar syndrome, cause a problem with an enzyme important to get rid of bilirubin.
  • Genetic factors. All of these factors are not well understood. If a baby in a family has jaundice, future babies may also have a higher risk. Babies of East Asian descent, for example, are more likely to have higher bilirubin levels.

Babies are closely watched for jaundice during the newborn period. Very often, pediatricians will use a blood test or device that measures the level of bilirubin through the skin. Based on the result and the risk factors, they decide if more monitoring or testing is needed and if the baby needs treatment.

How is jaundice in newborns treated?

The most common therapy, used for the vast majority of babies whose bilirubin levels become worrisome, is light therapy. The baby is placed under a special light (or wrapped in a special blanket with the light inside) which helps the body to get rid of bilirubin. It is safe and effective. When levels are extremely high and the possibility of brain damage is feared, therapies such as exchange transfusion, where blood is drawn and returned to blood, are needed. However, it is extremely rare.

Diet is also an important part of therapy because it helps the body get rid of bilirubin from the blood and urine. Feeding a newborn baby frequently can also help prevent jaundice problems. Babies should wet at least six diapers in a 24 hour period and should have regular bowel movements. The stool should change from the normal black, tarry stool of the newborn to a lighter colored, softer, “shabby” stool.

What should parents know about jaundice in newborns?

It is important for parents to watch their baby for jaundice when they come home from the hospital. Jaundice may be more difficult to see in babies with darker skin. A good way to look for it is to press for a moment on the baby’s skin in a place where the bone is close (the forehead, nose, chest, or shin are good places to do this). This briefly expels blood and should make the skin paler for a few seconds. If it looks yellow instead of pale, there may be jaundice.

Jaundice tends to spread from the face downward when bilirubin levels rise. For this reason, doctors worry much less about a yellow baby just around the face and upper chest than one that is yellow below the knees.

Call the doctor if your baby

  • looks more yellow, especially if it extends below the knees
  • eats poorly and / or does not wet at least six diapers in 24 hours and has regular bowel movements
  • is very sleepy, especially if he does not wake up to feed
  • is very difficult to console
  • arch your head or back, or act in a strange way
  • has a fever or vomits frequently.

Remember: Jaundice is common and serious problems are rare! But call your doctor if you are worried; prevention is always better than cure.

Follow me on twitter @drClaire

The post office Newborn jaundice: what parents need to know appeared first on Harvard Health Blog.


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