Bilirubin/Jaundice

Most infants appear jaundiced during the first few days of life. Jaundice in a newborn pertains to a yellow-orange skin color and whites of the eyes caused by too much bilirubin in the blood. Bilirubin is the main pigment that is formed by the breakdown of red blood cells and is made into waste by the liver.

A newborn’s liver has the task of breaking this excess bilirubin down and passing it from the body. Sometimes the liver cannot remove it fast enough from the body and more bilirubin is being made than the liver can handle. This is the most frequent reason for jaundice for babies. If bilirubin is allowed to build up in the body, it may cause medical problems.

The American Academy of Pediatrics recommends that all infants be examined for jaundice within a few days of life-this is the primary reason for your 4 day visit at Town and Country Pediatrics.

If you think your baby is jaundiced, call the office to speak to a medical professional immediately. In some cases, treatment is required and the sooner it is started, the faster the jaundice will go away.  

Types of Jaundice

There are several types of newborn jaundice. The following are the most common:

1. Physiological (normal) jaundice: occurs in more than 50% of newborns, this jaundice is due to the immaturity of the baby’s liver, which leads to a slower processing of bilirubin. Onset is 2 to 3 days of age, peak is 4-5 days and disappears by 1 to 2 weeks of age.

2. Jaundice of prematurity: this occurs frequently in premature (37 weeks and less) babies since they take longer to adjust to processing and exreting bilirubin effectively. Treatment is usually begun in the hospital before the baby is discharged.

3. Rh and ABO blood group incompatibility: onset during the first 24 hours of life. Related to blood type and a laboratory test called Coombs test, levels may get high but will decrease with treatment.

4. Breast milk jaundice: due to conjugation inhibitor (substance meant to break down bilirubin) in breast milk, onset is 4-7 days of age and lasts 3-10 weeks. It is not harmful.

Evaluation and Treatment of Jaundice

The evaluation of “significant” jaundice consists of comparing mother’s blood type and Rh, direct Coombs test on the infant’s blood and infant’s total serum bilirubin. An in office assessment (typically at your scheduled 4 day visit) is warranted- your infant will be weighed and a trans-cutaneous bilirubin (light passing through the skin) will be elicited with the bilimeter at Town and Country Pediatrics. This test is painless and is used along with physical assessment to determine if further blood testing is warranted to determine level of jaundice.

Treatment is determined based on the baby’s age and level of jaundice. Some jaundice is not treated. Phototherapy is the first line for treatment of excess jaundice. Phototherapy can take place in the hospital or preferably at home.  Home phototherapy uses a special halogen light, which alters the bilirubin so that it becomes easier for your baby’s liver to excrete it.  Fiber optic lines run from the light source to a panel that is Velcro strapped close to your baby’s skin. These panels are housed in a sheath and are not hot. Length of treatment varies from one to approximately 5 days depending on level of bilirubin (expect that bilirubin levels will be drawn daily either from a home care nurse or by bringing the baby to the hospital) and other factors.  Expect that your baby will have more loose, frequent green colored stools while undergoing phototherapy treatment. Phototherapy does not interfere with feeding or bonding with your newborn baby.

Sunlight is not a recommended mode of decreasing bilirubin for several reasons. The baby must be completely undressed to have his/her entire surface area uncovered, and newborns cannot maintain adequate body temperature without clothing or skin to skin contact with a parent at all times. Newborn babies have sensitive skin and should never be put in direct sunlight, because they are easily sunburned.

Very rarely, exchange transfusion is used to decrease jaundice. This method is used for very high bilirubin levels where the bilirubin is broken down especially fast. Exchange transfusion is accomplished by removing small amounts of baby’s blood and replacing it with equal volumes of compatible transfused blood from a donor (not mother’s). This new blood is not attacked by the mother’s antibodies and so therefore does not break down abnormally fast. Thus the level of jaundice is stabilized and will begin to decrease.

HOME CARE OF MILD JAUNDICE

 (in other words…you have been to the office and a

diagnosis of mild jaundice was made)

• If breast-fed, increase the frequency of feedings. Try for an interval of every 2-3 hours during the day.
• If bottle-fed, increase the frequency of feedings. Try for an interval of every 2-3 hours during the day.
• The more BMs (bowel movements) the more bilirubin comes out of the body. Watch the number of BM’s- if frequency decreases- call the office.
• Expected course of jaundice is to peak on day 4 or 5 then gradually disappear over 1-2 weeks.
• Call the office if:

      -you have questions!

            -jaundice is not gone by day 14 or reappears after day 7

            -baby is not getting enough milk, seems fussy, decreased BM

            -you think that baby’s weight needs to be checked

            -baby starts to act sick or tired and will not awaken for feedings

            -stools are white or light gray