Neonatal Jaundice. Introduction Neonatal jaundice or jaundice in newborn babies is a very common condition.

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1 Neonatal Jaundice Introduction Neonatal jaundice or jaundice in newborn babies is a very common condition. Newborn babies with jaundice are at an increased risk of complications that can lead to mental retardation, deafness, and other long lasting problems. Fortunately, most cases of neonatal jaundice go away on their own and are not serious. If your baby has severe jaundice, and your doctor recommends it, your baby may need treatment. This reference summary will help you understand what neonatal jaundice is, when it needs to be treated, its treatment options, and what to expect. What is Jaundice? Jaundice comes from the French word 'jaune', which means 'yellow'. When a person has jaundice, their skin looks yellow. The whites of their eyes can also turn yellow. A yellow substance called bilirubin is what makes a person with jaundice have a yellow color. It collects in the skin and the white area of a person s eyes. To understand jaundice, it is important to understand bilirubin. Bilirubin is an important part of red blood cells. Red blood cells are the oxygen carrying cells in the blood. Without Jaundice With Jaundice 1

2 When we breathe in, we bring oxygen into our lungs. Red blood cells pick up oxygen from the lungs. They take the oxygen to the cells of the body. As the cells use the oxygen, they release carbon dioxide, which is also called CO2. The red blood cells remove the CO2 from the cells and take it to the lungs where it is breathed out. The body gets rid of old red blood cells and replaces them with new ones all the time. Old red blood cells contain bilirubin, the substance that causes jaundice. Bilirubin is usually cleaned out from our body through the liver. The liver creates bile that has the bilirubin in it. The bile goes through the lower digestive track. Finally it leaves our body in stools when we use the bathroom. Bilirubin is what gives our stools their brownish color. Jaundice happens when there is too much bilirubin in the body and it is not being cleaned out and removed. The bilirubin that has not been cleaned from the body collects in the skin. The jaundice coloration starts going away when the bilirubin in the skin is picked up again in the blood and cleaned out. High bilirubin levels do not usually cause any long lasting problems. However, newborn babies with jaundice are at an increased risk of complications because some bilirubin can go into the brain. This can lead to mental retardation, deafness, and other long lasting problems. This is called kernicterus. Because of the risks that newborn babies with jaundice face, it is important to detect jaundice early and treat it. Babies jaundice is known as neonatal jaundice; neonatal means newborn. Causes There are many possible causes of jaundice. Sometimes a baby may be born with too many red blood cells. As the extra red blood cells die, the baby s system may have trouble cleaning out all these old red blood cells and their bilirubin. This leads to extra bilirubin in a baby s system. Another reason is that before a baby is born, the baby s bilirubin is usually taken care of by the mother's liver. Once a baby is born, he or she has to rely on his or her own liver to clean out the bilirubin. Sometimes a newborn baby s liver is not mature enough to take care of all of the bilirubin. 2

3 There are also many other possible reasons that a newborn may develop jaundice. Some of these reasons are more serious or rarer. There are some cases of jaundice for which doctors do not know the exact cause. Some babies are more likely to develop a severe type of jaundice. They include: Babies who are born prematurely. Babies who are not nursing well. If a baby is breastfeeding, the baby should be fed 8 to 12 times a day for the first few days to decrease the chances of neonatal jaundice. Babies who had a lot of bruising or bleeding under the skin and scalp during labor and delivery. Babies who have a brother, sister, or parent who have had neonatal jaundice and needed treatment for it. The good news is that most cases of neonatal jaundice are very mild, do not last long, and do not need treatment. Symptoms The main symptom of neonatal jaundice is a yellow color in the skin and the whites of the eyes. This yellow color can be seen clearest in daylight or under a fluorescent light. The symptoms of neonatal jaundice usually start showing up between 3 and 5 days of age. This can be earlier for premature babies. Jaundice usually starts in the face and then spreads downward to the rest of the body. Some babies with neonatal jaundice may be fussy and may not eat enough. Diagnosis A simple skin or blood test can be done to see if your baby has neonatal jaundice. This test finds out exactly how much bilirubin is in the body. Depending on how old your baby is and the level of the bilirubin in his or her body, treatment may be started. Newborn Blood Test 3

4 Treatment Most neonatal jaundice goes away on its own. Dangerous levels of bilirubin are not common but can happen. If your baby s bilirubin level is very high, your doctor may recommend phototherapy treatment. Phototherapy treats the extra bilirubin with a special light. The light changes the bilirubin and makes it easier for the body to clean it out. Depending on how healthy and how old your baby is, it may be done either at the hospital or at home. If your doctor recommends phototherapy for your baby at the hospital, your baby may be placed in an incubator. Special fluorescent lights that are known as bililights will be placed over him or her. While in the incubator, all clothing will be removed from your baby and a special mask will be placed on his or her eyes to protect them from the lights. Your baby will be turned from side to side to keep him or her comfortable. This also helps the light reach more of the bilirubin. If your doctor recommends phototherapy treatment for your baby at home, a special blanket known as a biliblanket can be used. A biliblanket is a blanket made out of a special fiber optic material that delivers a special light to make it easier for the body to clean out bilirubin. Biliblankets can be used in your home while you are holding your baby. When you use a biliblanket, your baby does not need a mask for his or her eyes. Biliblanket Phototherapy can last from a few days to about a week. As soon as the bilirubin levels start coming down to normal ranges, the therapy can be stopped. Phototherapy is very safe and effective. Most babies tolerate it extremely well. Phototherapy can cause dehydration so feeding your baby often is very important. It may also cause loose greenish stools, which is normal and will stop after the treatment ends. Some babies sleep very well during treatment and others are more restless. This is normal. 4

5 In rare cases, when the bilirubin levels are very high or the phototherapy is not working fast enough, the baby's bilirubin-rich blood may be replaced with normal blood. This is rare. If the jaundice was caused by other rarer or more serious diseases, there may be additional or different treatments. Your healthcare provider will let you know what he or she thinks is best for your baby. Summary Neonatal jaundice is a very common condition caused by a buildup of bilirubin. Bilirubin is a substance leftover in old red blood cells. It is usually cleaned out of the body through the liver and lower intestinal tract. If the body cannot clean all of the bilirubin out, it may build up in the skin and the whites of the eyes, making them look yellow tinged. Neonatal jaundice can be caused by many different things. Sometimes babies with jaundice are born with too many red blood cells and the baby s body cannot clean the bilirubin out good enough. Other times babies may be born with a liver that is not mature enough to handle cleaning out all the bilirubin. There are other causes as well. Most cases of neonatal jaundice do not need treatment. Phototherapy is a common treatment for neonatal jaundice. Phototherapy uses special lights that change the bilirubin substance and make it easier for the body to clean out. The bilirubin can go to the brain and cause permanent damage. However, neonatal jaundice is usually not a serious condition and most of the time it goes away on its own or is treated easily. Make sure to have your baby checked for it. A simple skin or blood test can help your doctor decide if there is too much bilirubin. If your baby leaves the hospital within 72 hours, you should take her or him to a pediatrician within a day or two to make sure that jaundice is not setting in. 5