Thursday, February 9, 2012

Jaundice of the Newborn

Hyperbilirubinemia, also known as jaundice, is a common condition in newborns, as it is observed in 60% of full-term and 80% of pre-term infants. In most cases, jaundice is a benign condition. Nevertheless, symptoms must be recognized and treated appropriately to prevent the neurological toxicity called kernicterus (see below). 
In utero, infants rely on oxygen supply from the mom’s bloodstream. In order to transport as much oxygen as necessary to the developing vital organs, unborn babies have an extra amount of red blood cells (RBC) that carry oxygen where it’s needed. After birth, those additional RBC are no longer necessary and start to break down, producing bilirubin, the yellow pigment that accumulates in the skin and eyes, called jaundice.

The so-called physiological jaundice occurs in more than 50 percent of newborns. The bilirubin levels rise on day 2-4 of life and are caused by the slow processing of bilirubin by the immature liver. The physiological jaundice may last for 1-2 weeks and the levels of bilirubin that are reached are harmless.

About 5-10 percent of breastfed newborns may have breast-feeding jaundice. This type of jaundice is caused by inadequate intake of breastmilk, thus dehydration and inadequate caloric intake. It appears around day 2-4 of life and lasts for 1-2 weeks.

The third type of jaundice is breast-milk jaundice that occurs in 1-2 percent of babies who are breastfed. This type of jaundice is related to an enzyme secreted in breast milk. This enzyme is responsible for increased absorption of bilirubin from the intestines. The breast-milk jaundice starts on at 4-7 days of life and may last for 3-10 weeks.

If your infant was born jaundiced or jaundice occurred within the first 24 hours after birth, she may have jaundice related to blood incompatibility. If the mom and the baby have different blood types, the mom may start to produce antibodies that destroy the newborn’s RBC. This causes sudden buildup of high levels of bilirubin that is evident within the first day of life. Should that happen, the infant will be placed under special lights (phototherapy) that will help her bilirubin levels decrease rapidly. Very rarely, when the levels of bilirubin do not decrease with desired speed, the baby may require a blood transfusion to prevent kernicterus.

To make sure that your infant is healthy and safe, always follow the advice given to you at the hospital or at your health care provider’s office. Determining the cause of jaundice and assessing the level of bilirubin in your newborn is always very important in order to prevent possible serious complications.

If your health care provider decides that your baby has physiological jaundice, you will need to feed you infant frequently (every 1-2 hours) and place her by the window, so that she is exposed to daylight. Frequent feedings will promote frequent bowel movements with which bilirubin will be excreted. In addition, resting in a sunny spot will help your infant’s body breakdown bilirubin more readily--thus jaundice should improve faster!

If your newborn is diagnosed with breast-feeding jaundice, your health care provider may suggest more frequent feedings, or alternating breastfeeding and formula bottles. And if breast-milk jaundice seems to be the problem, you may need to stop breastfeeding for 48 hours and supply your infant with formula during that time.

Whatever the cause of your newborn’s jaundice, if you are uncomfortable with how she looks or acts, NEVER hesitate to contact your health care provider for advice.

What is Kernicterus?
Kernicterus is a neurologic syndrome resulting from bilirubin accumulationg in brain cells. The duration of exposure to higher levels of bilirubin to produce toxic effects is unknown. Kernicterus is usually associated with bilirubin levels >20mg/dL. The initial sign and symptoms are lethargy, poor feeding, and loss of Moro reflex. Progressively, the infant may start to appear very ill, experience respiratory distress, convulsions, and produce a shrill high-pitched cry. Survivors of kernicterus may experience mental retardation, deafness, and spastic quadriplegia. To help prevent this condition, always follow-up with your health care provider as directed at the hospital or in the office.

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