Note: As with any health issue, contact your child's health-care provider if you have any concerns. |
What you need to know for the first few weeks of your baby's life
Jaundice is a concern that many parents of healthy newborns face in the early days and weeks after they welcome their new little one into the world. Jaundice occurs in 50-70% of all newborns. Here is some basic information to help you learn more about the condition so you will be better informed in case this is a situation you face.
The medical term for jaundice is actually hyperbilirubinemia, which means there is too much bilirubin in the blood. Red blood cells normally break down after use. When they do, bilirubin is produced and must be removed from the blood. Bilirubin passes through the liver where it is broken down for excretion through the intestines as bile. When bilirubin collects faster than a newborn's liver can break it down or the body can excrete it, jaundice occurs.
Types of newborn jaundice
Physiological (normal) jaundice - A newborn typically makes and uses more red blood cells than an adult uses. In the womb, the baby's bilirubin is cleared from the blood by the placenta and carried away through the mother's liver. As the newborn enters the world, her little liver has to begin to remove the bilirubin on its own. Sometimes it cannot immediately keep up at the rate that is necessary. The intestines may also be slow to remove waste and not removing it fast enough to prevent bilirubin from being reabsorbed.
Prematurity jaundice - Jaundice frequently occurs in premature babies (delivered earlier than 37 weeks gestation) because their livers are less ready to process bilirubin adequately. Premature babies will have bilirubin monitored more closely than full-term babies will. Medical providers may also advise more aggressive interventions than would be suggested in a full-term baby to reduce risks of additional complications.
Breastfeeding jaundice - Breastfeeding can also cause jaundice to appear or worsen. Fluids are necessary to help remove waste, including bilirubin, from the body. When a breastfed baby is not getting enough breast milk for whatever reason, it can lead to a less hydrated state. Less hydration allows for a higher bilirubin concentration in the blood and jaundice.
Breast milk jaundice - In a small percentage of breastfed babies (1-2%), jaundice may actually be a result of a substance in the breast milk that causes the bilirubin level to rise even when the baby is drinking adequately and well hydrated. This type of jaundice typically develops 4-7 days after delivery and the initiation of breastfeeding, tends to last longer than physiological jaundice, and does not tend to have any other identifiable cause. While the exact etiology is not clearly understood, there seem to be several enzyme related factors that play a role. Breast milk jaundice has a strong rate of recurrence in siblings.
Incompatibility jaundice - Jaundice conditions can also occur when there is a blood group difference between mom and baby. When Rh or ABO blood types are not the same, mom might produce antibodies that try to destroy the baby's red blood cells. The destruction of red blood cells causes a sudden build up of bilirubin in the baby's blood.
Bruising related jaundice - The birth process is hard work for you little one and sometimes bruising occurs during delivery. If your little one has some faint bruises, she may also have a slightly elevated level of bilirubin as well since more red blood cells are being broken down and releasing bilirubin.
What to Look For in Your Newborn
Symptoms of jaundice typically begin a few days after birth. The skin on the face begins to look yellow. It is possible to progress to include the chest, stomach and in the more severe cases the legs as well. Sometimes it looks like your baby has a "tan" instead of the pink color seen in the hours after birth. It can be harder to notice by sight in darker-skinned babies compared to light-skinned babies. One way to check for jaundice is to press your finger lightly on the tip of your baby's nose. If the skin appears yellow where you pressed, jaundice is likely. You can also use the forehead to check as well. Babies without jaundice will briefly have a color that is slightly lighter than their normal color when you do this check.
You may also notice the whites of the eyes having a yellow tint as well. The American Academy of Pediatrics guidelines recommend newborns be examined every eight to 12 hours after birth for the first 24 hours and then again at 3-5 days after birth. It is important to meet with your health care provider between 3-5 days after birth when jaundice levels are typically at their highest, so your baby can be checked.
Typically, a blood test is conducted to checked bilirubin levels if jaundice is observed. Most times simple monitoring is all that is necessary and no other treatment is required. If you are breastfeeding and jaundice is identified, it is important to get support and intervention from a lactation consultant if you are having difficulty getting a good latch, your baby seems to have a weak suck, or you are experiencing any other nursing issues.
It is important to feed all newborns every couple of hours in the first few days of life so they are eating about 8 to 12 times in a 24-hour period. This applies to bottle-fed as well as breast-fed babies alike. If you have a sleepy baby, this may require that you use techniques to arouse them for a feeding and initiate feeding on a schedule instead of on demand until they have seen their medical provider a few days after discharge and have received the "all clear" related to jaundice.
Sometimes additional treatment is necessary using phototherapy. Babies are placed under a special fluorescent light so the skin can absorb the light, which will change the bilirubin and make it easier to rid via the stool and urine.
What Parents Should Do
Because jaundice is common, it is important to remain calm if you hear your newborn has it in the first week of life. Talk with your medical provider about what they believe the cause could be and what you should watch for as you care for your newborn. Information is power and can ease your mind in those first few days of your role as parent. The Mayo Clinic suggests you contact your doctor if:
Newborn Jaundice: What You Need to Know
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