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The Informed Parent

Newborn Jaundice Can Be A Medical Emergency

by John H. Samson, M.D., F.A.A.P.
Published on Feb. 14, 2011

Newborn jaundice is a common issue in the neonatal nursery and the home after discharge from the hospital. Frequently the baby goes home without any jaundice, only to develop it over the next few days. What is done during this immediate time at home can effect the infant for the rest of his life.

Jaundice (yellow coloration of the skin) is provoked by deposition of bilirubin in the skin. The bilirubin comes from inside the red blood cells as they normally break down and are replaced by new ones.

Unfortunately, the newborn liver may not yet be functioning completely. The bilirubin is not detoxified and excreted out of the circulation. Therefore, it is deposited in the skin. This is not the problem. It also is deposited in the brain if it gets to a high enough level, that can be a terrible problem.

Bilirubin deposition in the skin causes no direct problem, but in the brain it may seriously damage critical parts. This leaves the newborn with a damaged brain for life. This nervous system damage (kernicterus, brain damage from deposition of bilirubin in the central nervous system) does not occur unless the serum bilirubin gets above 20 or 25 in an otherwise normal full-term baby.

If we monitor the serum bilirubin daily we can follow the elevation. If it approaches 20 we can order photo therapy (bili-lites) to be done at home or in the hospital. This reduces the serum level and keeps it below the dangerous value until the liver starts working to detoxify and excrete the bilirubin pigment.

We know bili-lites reduce the serum bilirubin by detoxifying the pigment in the skin. We also know that sunlight and certain types of artificial light sources do the same thing.  Putting a baby partially clothed by a window does not do the trick. Placing a baby under an incandescent light does nothing. Laying an infant clothed under a fluorescent light is not beneficial.

Without an incubator to keep the body temperature stable, placing a naked infant in direct sun would lead to unstable temperature and radiant exposure to the skin. In the hospital we use multiple banks of lites with the baby in an incubator.

The bottom line: if you think your newborn baby has jaundice do not waste valuable time by putting him in the sun or under a lamp. Take him to your pediatrician and let the doctor decide what needs to be done. If you call the office and a nurse tells you to put your newborn in the sun or under a lamp, do not do it! Demand to have the baby checked in the office or get a stat serum bilirubin at a lab which your pediatrician can order. Kenicterus is a devastating condition that can damage a brain for life, and many times totally preventable.

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