Fight Jaundice in a Newborn

In the newborn infant, jaundice is the most common condition diagnosed and treated by pediatricians. About 50% of full term infants and about 80% of preterm infants develop jaundice. Jaundice is occurs when newborns have difficulty breaking down bilirubin, a yellow-colored pigment of red blood cells. The main symptom of jaundice is a yellow tint to the skin and whites of the eyes. In cases where newborns require medical attention for jaundice, treatment is usually effective.

Steps

Identifying Jaundice in Newborns

1. Recognize the symptoms of jaundice. The main symptoms of jaundice are a yellowish tint of the skin — most notable in the palms and plantar surfaces of the feet — and a yellowing of the whites of the eyes. Most babies with jaundice don’t require treatment. You should still be aware of indications that the jaundice is getting worse.
   • A deeper yellowing of the skin is a sign that jaundice may be getting worse.
   • Watch for signs that the yellow tint is spreading to other parts of the baby's body like the abdomen, arms or legs.
   • If your baby is listless, it could be a sign that the jaundice is becoming more severe.
   • If your newborn is not feeding well and unable to gain weight it might mean the jaundice is worsening.
   • High-pitched cries from your baby are a sign that the jaundice is getting worse.
2. Test your baby for jaundice. The baby may not have been diagnosed with jaundice at the hospital. If you suspect jaundice once the baby gets home, try a skin test that's reliable, fast and easy. If you have any concerns, don't hesitate to contact your doctor.
   • If your baby has fair skin, try the following: Press a finger against your baby's skin. This will push the blood out of the skin for a moment. The infant’s skin should turn white. If the skin remains yellow, it’s jaundiced.
   • Perhaps the best place to notice mild jaundice is by gently pressing the tip of your infant's nose which is has many blood vessels and where jaundice is easily seen
   • Perform this test in a well-lit room so that you can identify skin color changes with ease.
   • If your baby has darker skin, check for yellowness in the whites of the eyes, nails, palms or gums.
   • Contact your doctor if your baby doesn't pass the skin test.
3. Take your baby to the doctor for a diagnosis. Your baby's doctor will measure the level of bilirubin in your baby’s blood by puncturing the heel to draw blood. The level of bilirubin detected in the baby’s blood will significantly contribute to assessing the level of severity of the jaundice and whether the condition needs treatment.
   • A skin test might also be conducted, using a transcutaneous bilirubinometer to measure the reflection of light shone through the infant's skin. The bilirubinometer is less invasive than drawing blood from the newborn.
   • It’s possible that your doctor orders additional blood or urine tests if underlying problems are suspected.
   • To determine that treatment is needed, the doctor will look at how well your baby is feeding to assess how your baby is affected by the jaundice. Other factors like whether the birth was premature, whether bruising occurred at birth, and your baby's age might affect the treatment plan.
   • If your baby has older siblings who have had severe jaundice, this will also factor into the treatment plan.
4. Seek emergency treatment if symptoms are severe. If jaundice is left untreated, bilirubin can enter the baby’s brain, causing a condition called acute bilirubin encephalopathy. Prompt treatment is critical before brain damage occurs. There are behavioral and physical symptoms indicating this condition. Note that your infant should be under the care of a doctor long before these symptoms develop. During acute bilirubin encephalopathy, the newborn may:
   • Develop a fever or vomit
   • Arch her back or neck
   • Be listless and difficult to wake
   • Feed poorly
5. Understand the importance of treating jaundice. Most cases of jaundice subside on their own in one to two weeks. There are also times when it's critical that jaundice be treated. Kernicterus, though rare, occurs when bilirubin has caused permanent brain damage.
   • Uncontrolled or involuntary movements are evidence of Kernicterus.
   • Loss of hearing can be an indication of brain damage.
   • A frozen upward gaze can be a sign of brain damage.

Treating Jaundice in Newborns

1. Treat uncomplicated jaundice with filtered sunlight. By far the best way to treat simple, uncomplicated newborn jaundice is by exposing your infant to filtered sunlight either through a polarized window or shade in your home or by taking him outside in a covered stroller for five minutes twice daily. The infant should not be exposed to direct sunlight, but can benefit from sunlight filtered through a shade or glass specifically treated to allow blue light through while blocking ultraviolet rays.
   • Some pediatricians are reluctant to recommend this due to the harmful effects of sun rays on sensitive infant skin; however, all over the world this is still the preferred treatment as long as parents are mindful of the amount and type of exposure.
2. Increase daily feedings for your baby. Breastmilk is important to your baby because it encourages bowel movements, which help to remove bilirubin from the baby’s system. The more your baby feeds, the more milk is produced and the more bilirubin your baby excretes. Your doctor may suggest an increase in feeding.
   • A breastfed baby may be upped from eight to ten feedings per day. Supplementation may also be suggested.
   • The newborn should be kept hydrated to help excrete bilirubin from their body.
   • A formula supplement to breastfeeding may be necessary to keep your newborn hydrated. Excess loss of water can occur through the newborn’s skin.
   • Consider working with a lactation professional to ensure the baby is feeding properly. A lactation professional can also help with supplementation.
3. Lower your newborn’s level of bilirubin with phototherapy. Your doctor may order light therapy for you baby either at home or in the hospital. Your baby will be placed under special lighting that emits blue-green light. This changes the shape and structure of the bilirubin molecules so that they can be excreted in urine and stool.
   • The baby will be weighed each day and the levels of bilirubin in your newborn’s blood will be checked often.
   • Your baby will wear a diaper and protective eye patches during treatment.
   • The light isn't an ultraviolet light. A protective shield filters out ultraviolet light that may be emitted.
   • Light therapy may be supplemented with the use of a light-emitting mattress or pad.
   • If standard phototherapy doesn’t work, the doctor might suggest the baby be placed on a fiber optic blanket; an additional bank of lights might be added.
   • Physiological jaundice (the most common form) almost never requires treatment beyond phototherapy.
4. Replace the baby’s blood with blood from a matching donor. An exchange transfusion may be ordered by your doctor if the bilirubin levels in your baby’s blood remain high. Your newborn will receive new blood through a small plastic tube inserted into a blood vessel. The bilirubin-heavy blood will be replaced with bilirubin-free blood reducing levels quickly.
   • Your baby’s condition will be closely monitored throughout the transfusion process.
   • An exchange transfusion can take several hours.
   • When the transfusion is completed, your baby’s blood will be tested for bilirubin. If the levels haven’t dropped enough then the baby will undergo another transfusion.
   • An intravenous transfusion of an immunoglobulin might help to prevent the necessity of a blood transfusion. It introduces a blood protein to the infant that that can reduce levels of antibodies.
   • An intravenous transfusion of an immunoglobulin could decrease jaundice and eliminate the need for an exchange blood transfusion.

Reducing the Risk and Impact of Jaundice

1. Test your blood early in your pregnancy. There are certain blood types that conflict between mother and baby. If the mother’s blood cells access the baby’s by crossing the placenta, the mother can form antibodies which lead to jaundice in the newborn.
   • ABO as well as RH incompatibility can lead to jaundice and can be detected in an early blood test.
   • Blood type incompatibilities  can be prevented with an RH-immune globulin administered at twenty-eight weeks in the pregnancy.
2. Anticipate jaundice in your newborn. Feed your baby often, since you can help your newborn to keep bilirubin levels manageable by increasing bowel movements in the baby. Even if your baby hasn’t been diagnosed with jaundice, you can anticipate the possibility of an increase in bilirubin levels and reduce those levels.
   • Eight to twelve feedings daily will help in reducing the risk of an onset of significant jaundice.
3. Avoid lifestyles that can lead to preterm labor and birth. High bilirubin levels resulting in jaundice occur in eighty percent of preterm babies. Bilirubin levels were found to be high, almost without exception, in babies born at thirty-five weeks or less increasing the risk of jaundice.
   • Refrain from smoking cigarettes—they increase the chances of preterm birth. Secondhand smoke also increases the likelihood of preterm birth.
   • Drug use contributes to preterm birth.
   • Alcohol consumption can also contribute to the likelihood of preterm  birth.

Tips

• It may be helpful to rent a hospital grade breast pump (and it may be paid for by insurance or WIC.). Do not try to use a "store-bought hand held" pump. You need a great pump to express milk to feed to your baby and keep up your supply (something with a multi-cycle adjustable suction control).
• Some pediatricians advise a breastfeeding mother to supplement with formula.
• The best preventative measure for jaundice is feeding your baby frequently (8-10 feedings per day), so that the bilirubin level in the baby's system is reduced through bowel movements.
• There is some evidence to suggest that delayed cord cutting can reduce or avoid jaundice in a newborn. The World Health Organization (WHO) endorses the practice.
• Note that your child may become sleepy. This is a normal result of the jaundice. If the baby is sleepy and breastfeeding less than 8 - 10 times/day, you may need wake the baby up to try to feed it.

Warnings

• Untreated jaundice can lead to severe problems such as damage to the brain or the central nervous system.

Things You'll Need

• A hospital-grade rental breast pump, if baby doesn't breastfeed well or often enough.

Related Articles

• Lower Bilirubin
• Keep Your House Clean with a New Baby
• Help Your Child Accept a New Baby
• Prepare for the Arrival of a Newborn As a Father
• Choose a Baby Name
• Get a Newborn to Sleep Through the Night
• Wear Your Baby

Sources and Citations

See also

• Lift and Carry a Baby
• Determine if Your Infant Has an Ear Infection
• Give an Infant Medicine
• Treat Allergic Colitis in Babies
• Diagnose Allergic Colitis in Babies
• Get Rid of Thrush in Infants
• Burp Babies
• Burp a Sleeping Baby
• Get Rid of Baby Hiccups
• Prevent Infant Constipation

Read more ...

What links here

• Balance Breast Size During Breastfeeding
• Get a Newborn to Sleep Through the Night
• Prepare for a New Baby
• Prevent Jaundice in Newborns
• Wear Your Baby