27 Sep Jaundice

Jaundice

Your cute baby has finally arrived with his perfect little ten fingers and ten toes, and then suddenly two or three days later this very kissable soft skin has this strange yellowy tone to it. Not only is his skin yellowy but the whites of his eyes are yellow too! The chances are he has jaundice. This is generally nothing to be alarmed about. It is a normal physiologic happening in the body. It occurs in 60% of full term and 80% of preterm babies. Jaundice is the name given to this yellowy colouring. This colouring is due to bilirubin being laid down under the skin.

Bilirubin is the by-product of the breakdown of red blood cells. Bilirubin is usually broken down in the liver and passed out in the urine and stools. Red blood cells breakdown every 120 days or so. Soon after birth there is the normal breakdown of red blood cells plus because your baby is now breathing its own oxygen and hence getting higher concentrations of oxygen they don’t need all those extra red blood cells like they did in utero when they were getting lesser concentrations of oxygen from their mother.

Jaundice is characterised by

• Poor feeding
• Increased sleepiness
• Increased yellowing of the skin and whites of the eyes
• Increased bilirubin level

During pregnancy, the placenta excretes bilirubin. When the baby is born, the baby’s liver must take over this function. Babies are born with immature livers so it can find it difficult to cope with this extra breakdown of cells. The jaundice appears after 24 hours, generally on the second or third day, reaching a maximum intensity by the fourth to fifth day. The majority disappears without any treatment.

If levels become very high, the bilirubin may cross the blood brain barrier and cause a rare, irreversible complication called kernicterus. This is why jaundiced baby’s blood bilirubin levels are monitored in very jaundiced babies. If the level is high, babies are placed under phototherapy lights to aid the liver in the breakdown of the blirubin. Offer frequent breastfeeds to ensure baby stays well hydrated.  Increased intake of colostrum will help the passage of meconium and pooing out the bilirubin and getting rid of the jaundice quicker.

Phototherapy works by converting the bilirubin to a more water-soluble form that is easily excreted. Your baby being under phototherapy lights does not necessitate your baby staying in hospital as portable lights can be set up in your home. As much of your baby’s skin as possible needs to be expose to the lights to breakdown the bilirubin as quickly as possible.

On the occasion a baby might develop breast milk jaundice. This jaundice tends to occur late in the first week or afterwards. It is due to something in the breast milk which tends to prolong jaundice. Usually baby’s weight is good and the baby is otherwise well. Jaundice may persist as late as 3 to 4 weeks, but usually will peak by 2 weeks. Just continue breastfeeding. No treatment is needed.