Jan 5, 2015

Dr. Gellner: You've heard that saying, having a baby changes everything. Well, it really does. And one of the first things that you need to be aware of as a parent is: Does your child have jaundice or not? What is jaundice and how you can help your baby is what we'll talk about today. I'm Dr. Cindy Gellner for The Scope

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Dr. Gellner: So you bring your beautiful pink baby home and within three to five days their skin goes from pink to yellow and their eyes turn yellow. What is it? It's jaundice, and jaundice is caused by a chemical called bilirubin.
Now you're baby's liver does not turn on until they are about a week old, and so all the red blood cells in their body only last a couple of days. When they start breaking down, since the liver is not turned on, the breakdown product of the red blood cells, called bilirubin, builds up in the baby's body. Until the liver is turned on and is able to break down that bilirubin, your child will continue to get more yellow. Sometimes this is a problem. Sometimes your baby's body is able to take care of it without any further complications

There are a few causes of jaundice. The physiologic jaundice is the one we just talked about, where it's due to an immature liver. Jaundice first appears by two to three days of age, and it disappears by one to two weeks of age and the levels of bilirubin are not high enough to need any further treatment.

There is breastfeeding jaundice. So breast feeding jaundice occurs when your baby does not get enough breast milk, and it occurs in about 5% to 10% of newborns. The symptoms are similar to those of the physiologic jaundice due to the immature liver. Sometimes babies who have breastfeeding jaundice need to be supplemented until the mother's milk is able to be fully produced and the baby can have all the nutrition he or she needs from the breast milk.

Breast milk jaundice occurs in about 10% of breast fed babies, and it's caused by a special substance that some mothers produce in their milk. The substance causes your baby's intestine to absorb more bilirubin back into his or her body than normal, and this type of jaundice starts at about 4 to 7 days old, and may last up to 3 to 10 weeks. This type of jaundice is not harmful either.

The kind of jaundice that we really do worry about is the kind where the blood types don't match. So this is where the mom is O blood type, and the baby is blood type other than the O blood type, or if the mother has the Rh negative factor. The blood types have a letter and either a plus or a minus, positive or negative. So if the baby's mom is negative and the baby is positive, what this means is that the blood types are going to sort of react with each other. If the mother has the Rh negative blood, her OB will know that, and the mom will usually get a shot called RhoGAM during her pregnancy and also within the first three days after delivery, and this prevents her from forming antibodies that might endanger other babies she has in the future.

But what about the baby that she currently has? This is where we find out the baby's blood type, find out if it's the same or different from the mom's, and if it's different we take that into close consideration with when we need to check the levels of bilirubin in the babies. They're always checked before the baby goes home from the newborn nursery, and then one of the things we check about at the visit when we see them a few days after nursery discharge is: Do they have jaundice? If they have jaundice, we can do the test for it, and if the bilirubin is high enough, then we can start the phototherapy.

The phototherapy is usually what people refer to as the bili-blankets or the tanning beds, because they look like that. It's basically blue light that helps break down bilirubin in the skin. Quite often we're able to get phototherapy to the home so the babies do not need to be hospitalized again.

How high a bilirubin level the baby can tolerate depends on how many hours old they are. So the older the baby is, the higher they can tolerate a bilirubin by themselves before we need to start the phototherapy.

If your child was a premature baby or they had a lot of bruising on the scalp, they may also have a lot of bilirubin build up, and that's another risk factor for when we would consider starting phototherapy at home.

So how can you help your baby not have jaundice issues? You want to feed your baby frequently. Make sure your baby is making several wet diapers a day, and you want to make sure that they are starting to have bowel movements, transitioning from that sticky, tarry meconium to the loose yellow seedy types of stools that they will have once all of that is out of their system.

The more the baby eats, the more the baby poops, the less yellow they'll be.

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