Practical advice for new parents

Jaundice in Newborns

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Jaundice in newborns is a common condition that describes the yellowish color of the skin and whites of the eyes. The condition itself is quite normal, affects around 50% of newborns, and in most cases is easily treated. There are instances however, although extremely rare, where severe jaundice can cause problems such as deafness, cerebral palsy, or even brain damage. It is therefore very important that parents consult with their health professional immediately if they suspect in any way that their baby may be suffering from jaundice.

Jaundice is caused by too much of a compound called bilirubin in the baby's bloodstream (sometimes referred to as neonatal bilirubin). Each and every one of us produces this chemical, and in turn it is our livers that take care of it (turning it into bile in our intestines). While the baby is in the womb, the mother's liver takes care of the processing of bilirubin for the baby. Once out of the womb, the baby's liver needs to do that function on it's own. However, when born, a baby's liver may not be sufficiently developed enough to take care of this function by itself. Hence the build up of bilirubin, and hence the yellow color. This is also the reason why a higher percentage of premature babies experience jaundice, as it is less likely that their livers will be sufficiently developed to cope with the levels of bilirubin in their system. The upside to premature babies developing jaundice though is that they are more likely to still be at the hospital when the diagnosis is made, and therefore will have round-the-clock monitoring of the situation and readily available treatments. For most full-term infants, the onset of jaundice is not normally noticed until the infant is a few days old and, most likely, at home.

There are also two other main ways in which a baby can develop jaundice - through breastfeeding and by way of incompatible blood groups between mother and infant.

With a small percentage of newborns, substances in the mother's breast milk will affect the efficiency of the baby's liver, thus helping to increase the amount of bilirubin in the baby's bloodstream. If you are breastfeeding and notice your infant developing jaundice, it will be virtually impossible from home to determine whether or not it is a direct result of the breastfeeding itself, or just a natural case of jaundice as outlined previously. It is important therefore to consult with a health professional as soon as possible to determine whether or not breastfeeding is the cause and should continue.

In cases of jaundice occurring because of incompatible blood groups, it sometimes happens that antibodies produced by the mother help to speed up the breakdown of red blood cells in the infant, thus increasing the bilirubin in the infants system (it is the breakdown of these cells that causes bilirubin to be produced in the first place). Treatments are available to the mother to ensure that subsequent children will not be affected by a similar condition but, again, for the child, early diagnosis of jaundice is important so that the infant can undergo necessary treatment.

Generally speaking, feeding your baby more often, but with lesser amounts, over the first few days helps the infant to pass stools more regularly and therefore helps to flush his/her system out. This, in turn, helps reduce the risk of excessive jaundice.


Symptoms of Jaundice


Jaundice usually becomes apparent in a newborn around the first few days after birth. The yellowing of the skin is most apparent firstly in the face (even in the whites of the eyes), then gradually migrating over the rest of the body. Because jaundice appears first on the face, new parents should take care to notice their baby's complexion and any changes in skin color that are apparent. Parents of darker colored babies need to be extra vigilant as jaundice can be naturally more difficult to detect on darker skin.

If you think that your baby might be developing jaundice, there is a quick home test that you can perform: press lightly with your fingertip against the tip of your baby's nose, or against the forehead. If the skin is white (regardless of your baby's skin color) at the point of the depression then jaundice is not present. If the color is yellowish, then jaundice is present and you should contact your doctor for advice. Err on the side of caution if you are unsure, and get your infant checked out.

Your doctor, or local hospital, can perform tests on your baby for the onset of jaundice. There are two methods: a skin test and a blood test. Generally speaking, the blood test is more accurate but obviously more stressful for the baby. The blood is normally drawn from the fingertip of the infant.


Treating Jaundice


In a reasonable percentage of cases, where jaundice is a result of simply too much bilirubin for the developing liver of your newborn to take care of, the jaundice should not last for more than a week or so. As your newborn's liver develops, it will become increasingly efficient at taking care of the levels of bilirubin in the bloodstream, and the yellowing color will dissipate.

For premature babies, or in instances where the level of jaundice is significantly higher, a course of phototherapy will be administered. This is where the baby is subjected to ultra-violet light for brief periods at a time. Ultra-violet light breaks down the bilirubin and makes it easier for the baby's liver to deal with it. While leaving your baby in sunlight will also help break down the bilirubin in your baby's system, this is not recommended as a treatment for jaundice. Your baby may end up with more complications by being directly exposed to sunlight. Do not undergo any form of treatment for jaundice on your baby without the express permission of your doctor.

Where the jaundice is a result of breastfeeding, your doctor is either likely to prescribe a period of rest from breastfeeding or, surprisingly, advise you to increase the frequency of breastfeeding in order to help the newborn pass the excess bilirubin in his/her stools.

In most cases once jaundice is eliminated (it can take up to 2 - 3 weeks) it usually doesn't return, but there are instances where it can, and does. It pays therefore to keep a close eye on the color of your baby's skin, and see a doctor or health professional if you suspect the return of jaundice in your baby.

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