By Shilpa Vernekar, M.D.
What is hyperbilirubinemia or jaundice?
Hyperbilirubin or increased levels of bilirubin/jaundice – is the yellow discoloration noted on the skin and the conjunctiva (the white part of the eye). Jaundice in newborns is fairly common.
When does it happen?
Most healthy newborns have jaundice during the first few days of life which disappears on its own without any specific intervention.
What causes jaundice?
Common causes of jaundice in newborns can be blood group or Rh incompatibility, trauma and scalp bleeding during delivery, infection, poor feeding, enzyme defects, RBC structural defects, biliary or liver conditions, metabolic conditions like hypothyroid, infants of diabetic mother and so on…
Why does it happen?
Newborns have relatively larger number of red blood cells (RBC ) with a short life span of these red blood cells. When RBC break down, bilirubin is formed as a byproduct. It is this bilirubin which imparts the yellow color to the skin and the eyes, or jaundice in neworns.
Jaundice may be categorized into two types:
- Physiological jaundice in newborns – This type of jaundice happens in most newborns. Start after the first day of life, reaches peak in 3-5 days in term babies and 5-7 days in preterm babies and resolves in 7-10 days.
a.) Breast feeding jaundice in newborns is another form of physiological jaundice. Decreased milk intake can exacerbate or worsen the jaundice. Breast feeding jaundice generally improves by increased and more frequent feeding of the baby.
b.) Breast milk jaundice in newborns is another type of physiological jaundice, where certain substances in the breast milk inhibit enzymes that are responsible for the breakdown of the bilirubin in the liver.
This jaundice generally happens by the second to third week of life and may sometimes stay for a month.
No treatment or intervention is necessary for physiologic jaundice in newborns.
- Pathological Jaundice- This type of jaundice in newborns can pose a problem. Jaundice that happens in the first 24 hours of life or jaundice that is higher than expected for a baby that age (in hours) needs to get medical attention.
How is jaundice diagnosed and treated?
Jaundice levels can be checked by a device on the skin which is a quick screening method. The definitive way is to take blood sample/heel stick from the baby and have it analyzed for bilirubin levels. In most cases of physiological jaundice, improved feeding helps flush the bilirubin out.
For breast milk jaundice, it is recommended to discontinue breast feeding for 48 hours, supplementing with formula in the meanwhile (pumping the breast milk to maintain supply). This method helps decrease the jaundice, after which breast feeding can be re-started without worrying about jaundice coming back.
Another treatment is photo therapy, where blue fluorescent light is used to break the bilirubin, which is then excreted to the urine.
In severe cases, an exchange transfusion may be necessary. This involves taking a small quantity of baby’s blood and replacing with a similar matched donor blood to decrease the bilirubin levels.
Why should I look out for jaundice?
If high jaundice numbers remain untreated, a condition called Kernicterus may develop.
This leads to long term irreversible brain damage. Hence physicians treat newborn jaundice aggressively.
It is important to ensure once you are discharged home from the hospital to keep the newborn follow up appointment within 3-5 days as jaundice levels peak in term babies by 3-4 days.
Also if you start to notice the skin color appear increasing yellow or jaundiced that lasts more than one week, it is important to have the baby checked out by the physician.
Finally, it is important to continue feeding the baby (through breast milk or supplemental formula depending upon your physician’s instructions,) and do not attempt to keep the baby in direct sunlight as this can result in dehydration, sun burn and more severe complications to the baby. Please do not worry, as with proper evaluation and treatment, jaundice in newborns is often easily resolved.
For more information, please consult your child’s pediatrician. This article is meant to serve as a guide about jaundice in newborns and is in no means is a comprehensive treatment plan for your baby.
Shilpa Vernekar, M.D., F.A.A.P. is a board-certified pediatrician who works at Preferred Medical Group, which has locations at Phenix City Children’s and Fort Mitchell Clinic. Her special areas of interest include weight management and nutrition. Follow Dr. V. on Twitter at http://twitter.com/shilpavernekar.