WCWG 20 - Greensboro CW | Newborn jaundice and kernicterus

By Amanda Genge, Staff Writer, myOptumHealth
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Most healthy newborns look robust and pink at birth. Within a few days, though, some babies will start to look a little yellow. This condition, called jaundice, affects nearly two thirds of all newborn babies.

Jaundice is caused by a buildup of a substance called bilirubin, a yellow pigment, in the blood. Affected babies may have a yellowish tinge to their skin and the whites of their eyes.

Your baby will be checked for jaundice in the hospital and then at well-baby visits in the days and weeks after birth. Jaundice can be harder to spot in newborns with darker skin tones. So these babies may need a blood test to check bilirubin levels, even if they are not showing other signs of the disease.

What causes jaundice?
Jaundice develops when red blood cells die, a normal process. When they break down, they form a substance called bilirubin. Before a baby is born, the mother's liver does the work of removing bilirubin. After birth, the baby's liver may not be developed enough to do the job well. When bilirubin builds up in the blood, it can cause the skin and eyes to look yellow.

Most of the time, jaundice will go away on its own.

Are there certain risk factors for jaundice?
Some babies are more likely to be jaundiced and have more severe symptoms than others. If your newborn has any of the following risk factors, your doctor may monitor the baby's bilirubin levels more closely:

• A sibling who had jaundice
• Problems feeding (and not enough wet and dirty diapers)
• Bruising at birth
• Preterm birth
• Early jaundice (within the first 24 hours of life)
• East-Asian or Mediterranean descent
• Mother with blood type O or Rh negative blood factor

How is jaundice treated?
When babies are jaundiced, it's important to make sure they eat often enough. A doctor may suggest increased feedings (nursing at least eight to 12 times per day, or bottle-feeding every two to three hours).This will cause more bowel movements, which help the body get rid of bilirubin.

Breast-fed babies with jaundice do not always need to be supplemented with formula. Simply waking baby to nurse more often and allowing him unlimited time at the breast can help. Your baby's doctor will tell you if your baby needs additional feedings by cup, syringe or bottle. If you are having trouble with breast-feeding, a lactation consultant can help you and baby get back on track.

If your baby's bilirubin level is too high, the doctor may suggest phototherapy (light treatment). Special light waves are absorbed by the skin and help break down bilirubin in the bloodstream.

Phototherapy can be done under lights in the hospital nursery or with a fiber-optic blanket, which can be used at home as well as the hospital. Your baby's doctor will tell you which is best for your baby's particular case. The baby may have to stay in the hospital a little longer for treatment and observation.

Some parents think that exposing baby to direct sunlight is good for treating jaundice. While sunlight may help lower bilirubin levels, it can be dangerous to baby. That's why the American Academy of Pediatrics does not recommend it as treatment for jaundice.

Very severe cases of jaundice may be treated with an exchange transfusion, where the baby's blood is replaced with donor blood.

Can jaundice cause more serious complications?
If left untreated, very high bilirubin levels can cause a type of brain damage called kernicterus. Jaundice is usually identified early and treated, so this complication has become very rare.

However, you should call the doctor right away if:

• Your baby's skin gets even more yellow
• The yellow color spreads to his belly, arms or legs
• Your baby is sluggish, floppy or hard to wake up; isn't feeding or sucking well; or becomes very fussy
• Baby develops a fever or high-pitched cry

The yellow color lasts for more than two weeks for formula-fed babies and three weeks for breast-fed babies.

SOURCES:

• Centers for Disease Control and Prevention. Frequently asked questions about jaundice and kernicterus. Accessed: 05/12/2010

• March of Dimes. Newborn jaundice. Accessed: 05/12/2010

• American Academy of Pediatrics. Jaundice. Accessed: 05/12/2010