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The Informed Parent

Questions & Answers: Jaundice

by Louis P. Theriot, M.D., F.A.A.P.
Published on Sep. 01, 1999

I am a grandmother with four grandchildren. My daughter just had a baby four days ago, and the baby has jaundice. I feel so foolish, but when we talked about it, I realized I really don't know what it is...let alone know what causes it. Could you please discuss jaundice? Does breast milk cause jaundice?

Jaundice is a common condition that occurs in most newborns. It usually starts in the first couple of days of life, and lasts for a few days before resolving. The majority of jaundiced babies do not require any specific treatment. If the jaundice is severe, however, there is a safe and effective treatment that can often be done at home.

Jaundice causes a yellowish discoloration of the babies skin. Bilirubin, which occurs naturally in our bodies, is the pigment that causes jaundice. Bilirubin is a byproduct of the breakdown of red blood cells which is constantly occurring in the body. After the red blood cell dies, it is broken down and the bilirubin is taken to the liver where it is excreted. The liver excretes the bilirubin through the intestines, and this is what gives the stool a brown color.

In the newborn, the bilirubin is often produced faster than the liver can get rid of it. The immature liver momentarily gets overwhelmed and needs a few days to "get going." Once this happens, the liver then functions just fine. Another cause of jaundice may be the over-production of bilirubin. This can occur when the mother's blood type (e.g. blood type O) and the babies blood type (e.g. blood type A or B) are not compatible. This causes an increased breakdown of the red blood cells which temporarily overloads the liver.

In the healthy newborn, jaundice usually becomes apparent in the first couple of days of life. It starts in the face, spreads over the chest, then causes the whites of the eyes to become yellow, and finally spreads to the arms and legs. An easy way to check for jaundice is to gently press on the nose, chest or palms. Normally, when you press and let go, the skin will blanche white for a second before returning to its normal color. With jaundice, when you press and let go, the skin will have an obvious yellow tinge to it.

There is a simple blood test that actually measures the level of bilirubin. This test requires just a few drops of blood and the results can be obtained in a few hours. Jaundice can be dangerous only if the bilirubin level reaches an extremely high level. The critical level depends on the babies age (prematurity) and the underlying cause of the jaundice. As a general rule, the bilirubin should be kept below twenty. A baby appears to be jaundiced when the level gets above four, and it usually takes days for the bilirubin to climb up into the teens. There is ample time to monitor, and follow the bilirubin before it becomes a problem.

One effective treatment of jaundice is more frequent feedings of breastmilk or formula. This gets the intestines working and will help in the excretion of the bilirubin in the stool. In more severe cases of jaundice, the babies can be treated with special lights that help get rid of the bilirubin. The lights cause a chemical change in the bilirubin which make it easier for the liver to excrete it. This is a very safe and effective way to treat the jaundice, and can usually be done in the home. In most cases, just a couple of days of the lights are needed to treat the jaundice.

In certain rare instances, the jaundice may be dangerously high. This may require that some of the babies blood be exchanged or replaced with fresh blood to get rid of the bilirubin. This is very uncommon.

You may have heard of "breastmilk jaundice". This occurs when a compound in the breast milk itself actually causes jaundice. This type of jaundice occurs later, usually after the first week. It is not very common, and occurs in 1:200 births. If the breastmilk is withheld for a short while (2-3 days) the bilirubin falls dramatically, and the mother can resume normal breastfeeding without any problems or concerns. The baby can be given formula while this is being sorted out, and the mother should pump her breasts to maintain a good milk supply.

Hopefully this answers some of your questions about jaundice. If you or your daughter have any other questions or concerns, be sure to check with the baby's doctor.

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