By Navin Gupta New Delhi, Nov 26th (IANSlife).Jaundice is a medical term for a yellowish tinge to the skin.
The yellow color is caused by bilirubin, a substance that is naturally made in the body.Babies with higher than normal blood levels of bilirubin, a condition called “hyperbilirubinemia”, get this yellow colour when bilirubin builds up in the skin.
Q: How common are jaundice symptoms in neonates?
A: Between 60 and 70% of newborns have jaundice.A majority of babies have mild to moderate physiological jaundice that doesn’t require treatment.
It usually begins within 24 hours of birth, and gradually increases to 10-14 mg/dl by the fifth day.Normal usually returns to normal between 7 and 10 days.
Q: What are the most common risk factors for jaundice in today’s world?
A: * Incompatibility of mother and baby’s blood groups (Mother O+ve and Baby is A+ve/B+ve, Mother is Rh-negative and Child is Rh-positive)
* Cephalhematoma — Blood collection under the skin of the scalp that is caused by instrumental delivery.It usually subsides in a few days.
* A previous sibling was diagnosed with jaundice and required phototherapy
* The baby is low in the G6PD enzyme.We can only find out about it after a blood test.
These situations require close monitoring of the baby until the 5th day of his/her life.Early follow-up is recommended after discharge.
Q: How can I estimate jaundice in my baby’s body?
A: Clinical estimation — The skin should be blanched in daylight to assess the condition.If the skin is yellowed from jaundice, the finger should be removed.Jaundice develops from head to toe.Eyes become yellow first, followed by the chest/ abdomen/ tummy and legs.If your baby’s soles or palms are yellow, you should inform your doctor.His levels could be higher than 20 mg/dl.Clinical estimation can be inaccurate.High interobserver variability.
Transcutaneous bilirubin-meter — This machine estimates the levels of bilirubin in subcutaneous tissue (tissue beneath the skin).It is non-invasive and can be used to estimate bilirubin.
The machine will estimate the bilirubin level if it is less than 13 mg/dl.
If the estimated level is higher than 13 mg/dl we should conduct a blood test.
Blood test — This is the best way to determine the level of jaundice.It involves taking a blood sample and estimating bilirubin in a lab.
Q: Peak levels in jaundice occur on the fifth day of life.When should one visit the doctor again?
A: Most babies are discharged from the hospital together with their mother within 24 to 72 hours after birth.
First, follow up should occur within 2 to 3 days after discharge.Nowadays, most hospitals will test for transcutaneous bilirubin prior to discharge.
A doctor may call you sooner than 2 to 3 days after discharge depending on the risk factors and the level transcutaneous bilirubin.
Q: What are some precautions you can take at home to ensure that jaundice does not rise quickly?
A: The baby should be fed properly at home.A subset of babies who have lost excessive weight experience jaundice.This is known as breastfeeding jaundice.It is not caused by breast milk.This is due to a low intake of breastmilk in the first few days.
It is normal for babies to lose 7-10% weight within the first four to five days after birth.
Q: Why should I worry about jaundice?
A: Babies whose blood bilirubin levels exceed 25 mg/dl can have irreversible damage (called acute-bilirubinencephalopathy) and permanent damage (called chronic bilirubinencephalopathy or kernicterus).
Q: What signs should one look out for in order to recognize signs of worsening jaundice at home?
A: * Palms, soles, and nails are yellow
* Your baby is having difficulty eating
* Your baby is more tired than usual
* It can be difficult to wake up your baby
* Your baby is easily frustrated and irritable.
* Your baby should bend their neck or backwards.
Q: What treatment options are available for jaundice
A: The goal of treating jaundice, is to reduce the amount of bilirubin as efficiently and safely as possible.Babies with mild hyperbilirubinemia might not require any treatment.
Treatment may be required for approximately 10-15% of hyperbilirubinemia babies.
* Regular breastfeeding — Breastfeeding is an important part in treating jaundice.
It helps to eliminate bilirubin from stools and urine.Your doctor can discuss options with you such as formula or donor breastmilk supplementation if your baby isn’t getting enough milk from breastfeeding.
If your baby has at least six diapers per day, their stool colour changes from dark green or dark green, and they are satisfied after eating, you will know they are getting enough milk.
* Phototherapy — Phototherapy (or “light”) therapy is the most popular medical treatment for hyperbilirubinemia.
Phototherapy is the best treatment in most cases.Special blue light is used to expose the baby’s skin to bilirubin, which breaks it down into compounds that are easier for stool and urine to eliminate.
* Exchange transfusion — This is an emergency procedure that can save your life and help to quickly lower bilirubin levels.Transfusion is a procedure that replaces baby’s blood with donated blood in order to rapidly lower bilirubin levels (usually within 2 to 3 hours).
Only babies who have not responded or who are at high risk of brain damage, such as those who are sick or who are unable to receive other treatments, can be given exchange transfusions.
Q: Can sunlight cure jaundice?
A: Sunburn is possible if ultraviolet rays are not filtered out.Phototherapy lights do not cause sunburn.
Q: What are the side effects of phototherapy treatments?
A: Although phototherapy is safe, it can cause skin rashes or loose stools.If a baby doesn’t get enough formula or breast milk, it can lead to overheating and dehydration.It is important to monitor a baby’s skin color, temperature, and number of wet diapers.
Q: Should a mother stop breastfeeding during phototherapy treatment?
A: Breastfeeding should be continued during phototherapy.If baby’s bilirubin levels are so high that they require exchange transfusions or if the baby is severely dehydrated, intravenous fluids (IV) may be administered.
Q: Does newborn jaundice have anything to do with the maternal diet?
A: Neonatal jaundice is not caused by maternal diet.It is usually due to immaturity in liver enzymes.
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