The word jaundice comes from the French word jaune, meaning yellow, and so we use jaundice to describe the ailment that causes a newborn baby’s skin to appear tinted yellow. This happens when there is too much bilirubin (or yellow pigments) from old red blood cells present in the body. Bilirubin is broken down by the liver and excreted by the bowel and the kidneys. When there’s too much of it, the bilirubin is sent to the skin, where exposure to ultraviolet sunlight helps to speed up the breaking-down process.
TELLING THE DIFFERENCE
It’s natural to worry if your baby looks yellow two or three days after birth, but if this is physiological or normal jaundice there’s no need for alarm. Reasons for normal jaundice are threefold: before birth, the placenta did most of the work for the liver, but now it has to get used to working independently. This can take time. At birth, a baby’s intestines are full of meconium – nine months of waste – that also takes time to be excreted. Slow or delayed elimination means bilirubin reabsorption. Finally, babies are born with a glut of red blood cells.
Baby’s first milk, called colostrum, is a mild laxative that helps to clean out the meconium. Babies who are reluctant to latch may not get enough of this magic milk and the jaundice that follows is called breastfeeding jaundice – which is different from breastmilk jaundice.
Breastmilk (or late onset) jaundice begins from about ten days after birth and can last for a few months. Babies with this type of jaundice are healthy and recover without treatment. It remains a mystery why breastmilk sometimes increases bilirubin reabsorption. Mothers are (in most cases) encouraged not to stop breastfeeding in these cases.
A more serious type of jaundice is called pathological jaundice. This usually begins within the first 24 hours after birth and bilirubin levels rise dangerously high very quickly. Pathological jaundice is usually caused by liver problems, a clash with mom and dad’s blood group, congenital infections or sepsis, genetic disorders, or bleeding under the scalp – called a cephalohaematoma. Swift action needs to be taken to reduce bilirubin levels if the baby has pathological jaundice. In rare cases, the baby may need a blood transfusion to prevent complications.
SYMPTOMS TO LOOK FOR
The biggest sign is a yellow tinge to your baby’s skin. This begins on the face and moves to the chest, abdomen, and legs. Jaundiced babies become lethargic and don’t latch properly – which increases bilirubin reabsorption and creates a catch-22 situation. When a baby doesn’t feed, this can lead to dehydration and low blood sugar levels.
Predicting the development and prognosis of newborn jaundice is not only dependent on blood tests. Jaundice is plotted against a specific nomogram that categorizes risk zones (low, low-intermediate, and high intermediate) and is also dependent on the baby’s postnatal age (in hours), as well as blood serum bilirubin levels. Premature babies are more likely to become jaundiced because their immature livers are unable to break down bilirubin.
About ten percent of all newborns with jaundice will need phototherapy. This works by exposing the naked baby’s skin to blue fluorescent light that interacts with the bilirubin in the baby’s skin. This makes it water-soluble so that it can be eliminated in the baby’s urine and stools. More recently, updated LED or light-emitting diodes have been introduced. These small, mobile units improve the amount of light energy that the baby is exposed to. They can be attached to the side of the bassinet in the nursery or NICU so that babies no longer have to be isolated in cumbersome incubators with their eyes covered.
Continue nursing your baby even when he is jaundiced, simply because breastmilk helps to eliminate bilirubin. This is evidenced in the yellow color of urine and stools when they change from black to mustard-yellow. If your baby is too lethargic to drink, express your breastmilk and feed her using a teaspoon, syringe, or small cup. Babies receiving phototherapy don’t need water to prevent dehydration, as breastfeeding your baby on demand will do this. Babies who are still jaundiced when they leave the hospital may continue with phototherapy treatment at home. Nursing sisters in private practice can bring a bilibed or mobile phototherapy unit to the house. They will also take bloods, check on breastfeeding and report back to the doctor. This way you don’t need to be separated from your baby so breastfeeding and bonding are not interrupted.
WHEN SHOULD I WORRY?
It’s important to take your baby to the doctor or clinic on the third day after birth for an overall check-up and to see if the baby is looking yellow. Also, take your baby to the doctor or clinic if she is not waking for feeds, is losing weight, has a few wet or soiled nappies, is running a temperature, and is looking more yellow. Taking your baby to the doctor or clinic as soon as you notice her looking yellow is also important, as it helps identify the type of jaundice and prevents any complications from occurring.