Neonatology
Jaundice (Hyperbilirubinemia)
What is Jaundice?
Jaundice
is a normal event that happens in most newborns.
While in the womb the baby makes more red blood
cells than is needed. Shortly after birth the
body breaks down these extra red blood cells.
Bilirubin
(which is the measure of jaundice) is one of the
parts of the red
blood cell that gets released into the blood
stream. As the level of bilirubin increases in
the blood stream, the undertone of the baby's
skin begins to look yellowish and the white parts
of the baby's eyes may also look yellow.
How does my baby get rid of excess bilirubin?
The baby's liver works to clear the extra bilirubin
out of the body. It is also cleared as the baby
begins to pass bowel movements and the bowel movements
begin to appear yellow. The process of clearing
the extra bilirubin normally takes three to five
days. We expect most babies to get somewhat jaundiced
during this time.
Why do you bother to check the bilirubin levels?
Sometimes the level of bilirubin in a baby's blood
can get too high. If this happens, it is possible
that the bilirubin can cause neurological problems.
This may occur if the level of bilirubin is above
the 20 to 25 range.
Some early signs of problem may include hearing
function abnormalities and at higher levels, this
may lead to severe brain damage. Your baby will
have at least one blood test before leaving the
hospital to determine if the baby is getting rid
of the extra bilirubin and to predict if your
baby will be at risk of having high jaundice during
the first week of life.
If the bilirubin level is either low or moderate,
we will feel comfortable sending the baby home,
but will tell you that the blood level needs to
be rechecked. This may need to happen in the first
two days after the baby goes home. This is because
the level usually rises for at least three days
and most babies leave the hospital before they
are three days old.
How do I get the bilirubin rechecked once
my baby goes home?
If your baby needs to have the bilirubin level
rechecked after going home, we try to make plans
that are the most convenient for you. Some insurance
plans will provide a home visiting nurse who will
come to your house to draw the baby's blood and
then call you with the results. You can also make
plans with your pediatrician to have the level
drawn at his/her office or at a nearby lab. Your
pediatrician will then follow the results, letting
you know if you need to make any adjustments in
feeding, or if you need to have the level drawn
again at a later time. Finally, you are always
welcome to return to the admissions lab here at
Pennsylvania Hospital, which is open seven days
a week. You will receive a call from a staff member
of the Newborn Pediatric office who will tell
you the baby's level and what else you may need
to do.
What if the level gets too high?
If your baby's level of bilirubin gets too high,
we will administer a special light treatment called
phototherapy.
These lights work by changing the bilirubin into
another less toxic substance, which is more easily
cleared out of the body. If the baby is under
phototherapy, the more time they spend under the
lights, the quicker the bilirubin will be cleared
away.
How long will my baby have to stay under phototherapy?
If your baby needs to receive intensive phototherapy,
he/she will need to stay in the hospital or be
readmitted to the hospital for phototherapy until
the bilirubin is coming down to a safe level.
The amount of time a baby needs to be under phototherapy
varies, but we do our best to predict the amount
of time treatment may last based on the baby's
level and other issues such as feeding and stooling
pattern.
Does how and what I feed my baby affect their
bilirubin level?
Since one of the ways bilirubin is cleared from
the body is through the bowel movements, the more
milk the baby takes in, the more bowel movements
will be produced and the faster the bilirubin
will be cleared away. For this reason, if the
levels are getting high or if the levels are high
enough to begin phototherapy, and you are breast
feeding, we and your lactation consultant may
recommend that you supplement breast feeding with
formula to ensure that the baby is getting as
much milk as possible. This supplemental formula
will only be needed until the jaundice level is
no longer a potential problem for your baby.
Does jaundice recur?
Jaundice observed in newborn babies is generally
not associated with recurrent jaundice and not
similar to that observed in adults unless your
doctor has identified a specific reason for the
jaundice in your baby.
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