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An Overview Of Newborn Jaundice

By Yvonne Cryns

All jaundice is caused by a build up of bilirubin. As the

 newborn's hemoglobin requirements decrease after birth and the excess red blood cells are broken down, the by-products of this process are globin, iron, carbon monoxide and biliverdin. The biliverdin is usually changed into indirect or unconjugated bilirubin which is fat soluble. The liver then processes the unconjugated bilirubin and it becomes direct or conjucted bilirubin (water soluble) and can be removed from the body through the feces or urine. Jaundice has been associated with a pathological problem called kernicterus which can cause brain damage.

Conjugated bilirubin -- in this type of jaundice, the bilirubin appear in high numbers in the blood and are caused by serious illness such as liver disease or disfunction. These are very sick babies whose jaundice is secondary to their other health problems because their livers are not functioning properly.

Unconjugated unbound bilirubin -- This is the most severe type of jaundice and can lead to kernicerus or bilirubin encephalopahy, a neurological condition which causes brain damage. This is seen in up to 25% of premature babies (under 32 weeks). The danger of this type of jaundice is that the bilirubin are unbound and theoretically can permeate brain cell membranes. There is difficulty in diagnosing the problem because bilirubin levels do not directly correlate with the development of kernicterus. Some symptoms that may alert the parent include lethargy, high-pitched crying, inability of baby to maintain proper body temperature, vomiting and lack of muscle tone. Other conditions may sugest pathology such as prematurity. Hr or ABO blood incompatibilities, the use of certain drugs by the mother prenatally or during labor and/or the giving of drugs to the baby.

Unconjugated bound bilirubin -- Known as normal physiologic jaundice, this is the most common type of jaundice. Babies exhibiting this type of jaundice become yellow a day or two or three after birth and the yellow color worsens until about the fourth day when it levels off and gradually diminishes.

TYPES

The three types of neonatal jaundice are physiological, breastmilk and blood groups incompatibility. 

Physiological - This is the most common type of jaundice and is present in about half of all healthy newborns. The baby becomes yellow at two to four days from birth and the color peaks and then diminishes. These babies are alert and active.

Breastmilk - About 1 to 2% of breastfed babies will develop this type of jaundice and become yellow during the second or third week. They are otherwise robust and healthy and nursing well. The jaundice will gradually go away.

Blood Incompatibility - The babies in this group can be monitored for problems if the mother's blood type and Rh are known. These babies will turn yellow within 24 hours of birth. The most common type of incompatibility is ABO and is usually mild. Those mothers who are Rh negative should be given Rho GAM appropriately to prevent future incompatibility problems.

MYTHS

Probably the biggest myth is that jaundice leads to or causes brain damage. Research is now stating quite emphatically that is not so, but rather, some underlying pathology creates an environment that permits the unbound circulating bilirubin to enter the brain cells and cause damage.

Another falsehood that is prevalent is that a baby with jaundice will "get better" only if breastfeeding is stopped and formula or glucose water is substituted. This has not been proven by the studies.

Frequently presented as medically necessary for yellow babies is the need for hospitalization with bililights. The bililights themselves are suggested as a risk free "cure" for jaundice, but they have numerous documented side-effects.

Jaundice is a normal response of the healthy term baby's system to a normal process. Unless the jaundice is immediate, severe, or the baby is acting sick, there is no treatment needed other than early and frequent breastfeeding and common sense exposure to sunlight. Mothers should be screened prenatally for blood incompatibilities. 

 

 * This website does not intend to give medical advice. You should consult a competent physician with important questions about your health.

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