Jaundice


Definition
Jaundice is a common and usually harmless condition in newborn infants. The word jaundice comes from a French word meaning "yellow". It describes the yellowish appearance of the whites of the eyes and the skin of many newborn babies.

Physiologic, or "normal", jaundice usually appears on the 2nd or 3rd day of life in healthy babies born after a full-term pregnancy. It often disappears within a week. Doctors estimate that as many as two thirds of full term babies get physiologic jaundice. It may occur in both breastfed and formula-fed babies.

Premature babies are even more likely to get normal jaundice. It may appear later and last longer in these infants, becoming most noticeable between the 5th and 7th days of life.

In most instances, the jaundice is mild and causes no problems. It disappears without treatment. However, if the condition is more severe, or if the jaundice is present at birth or appears during the first 24 hours of life, treatment will probably be necessary.

Major Causes
In most cases, jaundice occurs because the liver and the other organs are not fully mature. This is particularly true in very small or premature babies.

One function of the liver is to rid the blood of a yellowish substance called bilirubin (pronounced "Billy Reuben"). All during life, new blood cells are being created and old ones are being destroyed. As the old cells are broken down, hemoglobin, the red part of the cells, is changed into bilirubin and removed by the liver. Until the baby's liver begins to function fully, bilirubin can build up in the bloodstream, causing the skin and the whites of the eyes to become yellow. This condition is known as physiologic jaundice.

High bilirubin levels can occur for other reasons, also. Babies who are bruised at the time of birth and babies born to diabetic mothers are more likely to develop jaundice.

Two other, potentially more serious kinds of jaundice may occur when the baby's blood type is different from the mother's.

One of these conditions is called ABO incompatibility. The mother usually has type "O" and the baby has either type "A" or type "B" blood. If a baby has this condition, jaundice usually appears within the first 2 days after birth.

Another kind of jaundice occurs when the mother has Rh-negative blood and the baby has Rh-positive blood. When babies have this condition, jaundice may be seen at birth or on the first day of life.

Although there are other causes of jaundice, they are extremely rare.

Treatment
As stated earlier, physiologic (normal) jaundice is expected to disappear without treatment However, some babies may require treatment. This depends on whether they were born prematurely, how old they were when the jaundice occurs, the cause of the jaundice, and the severity. In any case, a physical examination is performed and laboratory tests are obtained if necessary.

Breastfed babies with physiologic jaundice should be fed 10 to 12 times a day, or every 2 to 2 1/2 hours, to increase there milk intake. On rare occasions, the doctor may advise that nursing be interrupted for 1 to 3 days if the bilirubin level rises too high. The mother can maintain her milk supply by expressing (pressing out) milk by hand or with the aid of a breast pump every 3 to 4 hours. Once the jaundice is under control, breast feeding may be resumed.

When jaundice does require treatment, a technique called phototherapy is usually used. Phototherapy simply means treatment using light. Light --either sunlight or artificial light-- speeds up the removal of bilirubin from the blood by the liver.

In phototherapy, the babies skin is exposed to special, high intensity lights often called "bililights". The baby's clothes are removed and the eyes are covered to protect them from the light. The baby is kept warm in an incubator or under a clear plastic shield that fits across the top of a crib. Temporary and usually minor side effects may include a rash or loose stools.

Phototherapy continues until the amount of bilirubin reaches and remains at a safe level. Some babies may need to stay in the hospital an extra day or two until this happens. The bilirubin level is checked regularly by testing a small sample of blood, often taken from the baby's heel.

Babies with severe ABO or Rh incompatibility or other severe forms of jaundice may need different and more rapid treatment. The most common and effective method is an exchange blood transfusion. During an exchange transfusion, a slender tube is inserted into the vein in the baby's umbilical cord stump. Blood is gradually withdrawn and is exchanged with the blood of a carefully selected donor. In this way, the excess bilirubin is removed. Exchange transfusions are performed with expert care and produce an immediate and significant decline in the blood bilirubin level.

If your baby has jaundice, you may want additional information about its cause and treatment. The baby's doctor can answer your questions about your own infant's condition.

Do not be alarmed if your baby has jaundice.

Remember
Jaundice in newborn babies is very common.
In the majority of instances, the condition is normal, harmless, and temporary.
When treatment is necessary, safe and effective methods are used.