Most newborns turn at least a little yellow in color. Known as jaundice, this condition is a very common and usually normal part of the newborn period. However, in some very rare cases, this can lead to (or be a sign of) a more serious problem. So parents need to know about it.
What causes jaundice?
The yellow color of neonatal jaundice is caused by high levels of a substance called bilirubin in the blood. Bilirubin comes mainly from the breakdown of red blood cells. It is processed in the liver to make it easier for the body to get rid of it through urine and stool.
Newborn livers take some time to operate when it comes to getting rid of bilirubin. 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 appear as the babies get older. The combination of these two factors is what makes jaundice so common.
Jaundice usually peaks in the first two to five days of life and lasts about one to two weeks. It may take longer for breastfed babies; We don’t know exactly why this is happening, but there is nothing to worry about.
Jaundice can actually protect the baby because bilirubin is an antioxidant that can help fight infections in newborns. This is another reason parents shouldn’t worry too much about a bit of yellow: not only is it temporary, but it can also help their baby if it leaves the safety of the womb.
In rare cases, jaundice can indicate a problem
However, sometimes 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 and affects far less than 1% of infants.
There are many conditions that can make bilirubin levels more likely to be high, including:
- Dehydration or insufficient calories. This is most common when babies are exclusively breastfed and a problem with breastfeeding is not recognized.
- The systems that get rid of bilirubin may not be ready yet.
- Infection or a blockage of the bowel. Jaundice usually wouldn’t be the only symptom for this.
- ABO or Rh incompatibility. If the mother and child have different blood types, the breakdown of red blood cells may be greater than usual. This is something obstetricians are very aware of and tests are done if there are concerns.
- Bruising or a cephalohematoma (a lump or bruise on the head). Both can happen during a difficult labor. These cause more red blood cells to be broken down.
- Liver disease. There are a number of different liver problems that can make it difficult for the baby’s body to get rid of bilirubin.
- Diseases that affect an important enzyme. Some diseases, such as Gilbert syndrome or Crigler-Najjar syndrome, create a problem with an enzyme that is important in clearing bilirubin.
- Genetic factors. Not all of these factors are well understood. If a baby in a family has jaundice, future babies may also be at higher risk. For example, babies of East Asian descent are more likely to have higher bilirubin levels.
Babies are closely monitored for jaundice during the newborn period. Very often, pediatricians use a blood test or a device that measures bilirubin levels through the skin. Based on the result and any risk factors, they will decide whether further monitoring or testing is needed, and whether the baby needs therapy.
How is jaundice treated in newborns?
The most common therapy used in the vast majority of babies whose bilirubin levels become of concern is phototherapy. The baby is placed under a special light (or wrapped in a special blanket with the light in it) that will help the body get rid of bilirubin. It is safe and effective. When levels are extremely high and there are concerns about the possibility of brain damage, therapies such as exchange transfusion, which involves drawing blood and returning new blood, are needed. However, this is extremely Rare.
Feeding is also an important part of therapy as it helps the body get rid of bilirubin in the blood and urine. Frequent feeding of a newborn can also help prevent jaundice problems. Babies should wet at least six diapers and have regular stools over a 24 hour period. The stool should change from the newborn’s normal black, tarry stool to one that is lighter and looser and “shabby”.
What Parents Need To Know About Newborn Jaundice
It is important for parents to keep an eye on their baby’s jaundice as they walk home from the hospital. Jaundice can be harder to spot in dark-skinned babies. A great way to look for it is to press for a moment on the baby’s skin where the bone is (forehead, nose, chest, or shin are good places to do this). This will push the blood out briefly and should make the skin paler for a few seconds. If it looks yellow instead of pale, you may develop jaundice.
Jaundice tends to spread down from the face when bilirubin levels rise. Because of this, doctors are far less concerned about a baby who is yellow only in the face and upper chest than about a baby who is yellow under the knees.
Call the doctor when your baby is
- looks more yellow, especially if it spreads under the knees
- poorly feeds and / or fails to wet at least six diapers in 24 hours and has normal stool
- is very sleepy, especially when they don’t wake up to feed
- is very fussy and difficult to comfort
- arches their head or back, or otherwise acts strangely
- has a fever or vomits frequently.
Remember: jaundice is common and serious problems are rare! But call your doctor if you are concerned. It is always better to be on the safe side.
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