The other day I received good news. My cousin had delivered. But, her baby developed Jaundice within the first week of her birth. Then I tried to recall, I faced this with both my babies too. And a friend also had a similar problem. Jaundice in newborn babies has become quite a common problem. But it is not something to be worried about if handled timely and properly. When my first-born was diagnosed with jaundice, I was quite alarmed. For me, jaundice was a problem of the liver that grown-ups had, and even in children, it was not something to be worried about. So jaundice in a newborn baby was a first for me then.
Excess levels of bilirubin in the blood cause jaundice. Bilirubin is a pigment that is produced as a by-product because of the regular breakdown and destruction of red blood cells. The liver processes bilirubin and forms bile juice that aids in digestion and is eliminated out of the body through the stool. When the formation and elimination of bilirubin are obstructed in any form, it leads to jaundice.
Newborn babies have higher levels of bilirubin compared to adults. Since the liver is not developed fully, the placenta does the job in the womb. But when the elimination of bilirubin is not done effectively, it leads to a higher level of bilirubin leading to jaundice.
Dr. Charu Kalra, a pediatrician and child nutritionist of Well Baby Clinic cites the following reasons.
Here’s why jaundice is common in newborn babies:
1. A large number of red blood cells
2. The life span of red blood cells in babies is less than that of older children
3. The liver is immature to digest large amounts of bilirubin
4. The abnormal shape of blood cells
5. Blood group incompatibility, i.e, a mismatch between the blood type of the baby and the mother
6. Premature babies (neonates born before 37 weeks of gestation)
7. Low oxygen levels at the time of childbirth
8. Any underlying infections at birth
9. Babies born to a diabetic mother
10. Insufficient feeding or irregular breastfeeding of the baby
Dr Kalra further cites that the most common entity in newborns is “physiologic’ jaundice. It usually doesn’t require any active treatment. But what the doctors worry about is pathological jaundice in newborns that occurs within twenty-four hours of birth, stays even after 5-7 days of birth, the level of bilirubin is very high and if the baby is sick.
Careful observation of the newborn baby will make one aware of the signs and symptoms of jaundice. Most of the cases it is the 2nd or 3rd day when the newborn baby is diagnosed with jaundice. For both my kids, they displayed symptoms of jaundice from the second day itself.
The signs and symptoms are as follows:
1. Yellow discoloration of skin and eyes: The most common sign is the yellowish color of the face and the eyes. Depending on the severity of jaundice, the yellow discoloration will increase from head to toe.
2. Refusal to take feed: The baby will not suckle properly and the intake of milk will lessen. In severe cases, the baby will refuse to take feed, will become lethargic, will sleep for long hours without feeding, and can even have seizures and fits (this is a rare yet severe case of jaundice where the bilirubin enters the brain.
3. Discoloration of urine and stool: Just like in adults, signs of jaundice can be understood by the urine and stool of the newborn for jaundice. Urine will be discolored and stool will be pale or dark-colored.
4. Loss of weight: The baby will start losing weight. During my second child’s case, he lost 300 gms in just two days!
5. Irritable and a cranky baby: Nothing will put the baby at ease. There will be constant discomfort because of which the baby will be irritable and will continue to cry.
How is jaundice diagnosed in newborn babies?
1. Before discharge, all the newborns are examined for visible jaundice (yellow discoloration of the skin).
2. A transcutaneous bilirubin monitor (TcB monitor) gives the estimate of bilirubin levels in newborn babies just by placing it over the skin. (but they give an approximate value)
3. Most specific is blood levels of bilirubin, which is done with just a few drops of baby’s blood. This was done in my second baby’s case.
So how are newborn babies treated for jaundice?
1. In most cases, no treatment is required and just adequate breastfeeding, about 8-12 times per day, will be enough, and jaundice will disappear by 7-10 days completely.
2. Keeping an eye on the baby’s urine and stool to check for any further discoloration.
3. If the bilirubin levels are high for age (which is estimated by scientific charts) the baby is given a special light treatment called phototherapy (with blue colored lights)
4. There are blue color blankets or biliblankets available in a few tertiary care setups where a baby is wrapped in these blankets for treating jaundice.
5. In severe cases when the bilirubin levels have gone so high to cause brain injury, these babies might require plasma therapy or exchange blood transfusion
Many times parents are asked to keep the baby under direct sunlight. But Dr Kalra warns against over-exposure. She says parents need to keep in mind the time of the day when they expose the baby to sunlight and the duration as well. Otherwise, it can lead to dehydration and exposure of the baby’s skin to harsh sunlight can be harmful.
by Tasneem Dhinojwala