Newborn jaundice
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Sweet Peas, Pods & Papas: All About Birth, B@@bs & Babies

Newborn jaundice

We are back from our babymoon!  It has been a wonderful five weeks of enjoying our baby instead of doing all of the regular day-to-day activities.  I didn’t do any blog writing or homeschooling through this time…we are slowly getting back to our routine.  We have continued on with our class series and all of our students have seen our baby grow into her 12-pound, 1-ounce weight and 24 inch length in the last five weeks.  Breast-milk is nature’s perfect food!!
Which brings me to one of the topics that we covered briefly at the end of class last night.  One of our Coaches asked if we are going to spend some time talking about jaundice.  The topic of jaundice has actually affected the care and breastfeeding relationship of three students in the last six months, up from absolutely none since we started teaching.
As with many things involving pregnancy, labor and newborn care, it is imperative that parents do their research and know where they stand before they arrive at the hospital.  Although complications from jaundice are rare, true complications lead to irreversible neurological damage to the child.  Because treatment is available and the damage is preventable, charges of substandard care or neglect are plausible.  Thus hospitals and pediatricians are pro-active and aggressive in their treatment of jaundice.

I have to ask myself why I am seeing red instead of yellow when it comes to jaundice treatment.  Answer: because pro-active and aggressive care that is not truly medically necessary can separate babies from the nurturing breast of their mother and the loving arms of their parents.  This can have a long-term and possibly negative effect on the breastfeeding relationship and family bonding.
“Bilirubin is a yellow pigment that is created as the body gets rid of old red blood cells. The liver helps break down bilirubin so that it can be removed from the body in the stool.”  (See Link 1 below)
Bilirubin in and of itself is beneficial to the body.  It is a bacteriostatic agent, meaning that it stops bacteria from reproducing.  This is a good thing in a newborn’s body – we want bacterial growth to be inhibited in our precious babies, especially if they are exposed to hospital germs.  It is also an anti-oxidant that inhibits the growth of free radicals in the body.  Free radicals cause damage or death to a cell, so inhibiting their growth is again, a good thing.
The condition known as jaundice is diagnosed because the skin, and maybe the sclera (the “white of your eyes”), look yellow-tinged.  An excess of bilirubin causes the condition.  It takes a few days for the body to process bilirubin effectively, however, as the newborn gets their systems “on-line”, the liver becomes efficient at processing the bilirubin and the yellowish pigment of the skin and eyes goes away.
Jaundice can be considered pathologic or physiologic.  The distinction in diagnosing which type of jaundice your baby has is determined by when the jaundice is noted in the newborn. 
Pathologic jaundice, which occurs within 24 hours of a child’s birth, needs to be treated immediately to avoid the neurological injury called “kernicterus”.  Kernicterus happens when an accumulation of bilirubin in certain brain regions causes irreversible damage to those areas.  It manifests as various neurological deficits, seizures, abnormal reflexes and abnormal eye movements.
Physiologic jaundice, which occurs on or around the second or third day after birth, is not generally considered dangerous and occurs in almost all newborns.  In the case of physiologic jaundice, the bilirubin levels never rise to the point of causing permanent injury to the child.  The bilirubin functions, as it should: ridding the body of bacteria and free radicals, and eliminating them through the baby’s stools.
There are two ways to treat jaundice.  If bilirubin levels are on what your pediatrician considers a safe increase, phototherapy may be the treatment of choice.  If the bilirubin reading is borderline dangerous or at dangerous levels, a blood transfusion is the quickest way to reduce bilirubin levels; and more than one may be indicated.
As I read up on jaundice in preparation for writing today’s post, I was so glad to read that many medical professionals agree that there is NO REASON TO STOP BREASTFEEDING your baby.  I put it in caps because I feel it is important for parents to know they are supported in their right and their desire to breastfeed their child.  Breastfeeding is not the same as supplementing with breast-milk in a bottle, or substituting with inferior formula products.
Since this is not a medical blog, I am going to add in some vocabulary words that you may want to add to your list of “things to research”, and listen for them as your baby is evaluated for jaundice. I will close with an excerpt from a site that delineates when parents should be concerned, and with some suggested links to serve as a starting point for additional reading.
Exchange transfusion – used to rapidly remove bilirubin from circulation
Hyperbilirubinemia - increased levels of bilirubin in the extracellular fluid
Intensive phototherapy – uses blue light for treatment of jaundice – can be an “incubator” or a blanket (note: you could hold your baby on your lap if you use a blanket)
Phototherapy – standard treatment for jaundice: at home, daily exposure to indirect sunlight; in a hospital setting, most commonly uses fluorescent white light 
TSB – total serum bilirubin
Transcutaneous – noninvasive techniques for measuring bilirubin levels
If the bilirubin concentration is found to be greater than 10 mg/dL in a pre-term infant, or greater than 18 mg/dL in a term infant, additional testing will be done.  Here is a list of what those additional tests might be: Hct, blood smear, reticulocyte (red blood cell) count, direct Coombs’ test, G6PD test, TSB and direct serum bilirubin concentrations, and blood type and Rh group of infant and mother.
When you are evaluating what course of testing or treatment to follow for jaundice, remember the following assessment tool.  I included some sample questions for this situation.

B – Benefits:  What are the benefits of this test over the other available tests?
A – Alternatives: Are there any alternative tests we could consider if we feel this is too invasive or the risks are too great?
R – Risks:  What are the risks or side effects of the test you are recommending?  How do you do this test?  What else will you do - or can we expect to happen - to our child if we agree to this test?
Excerpts from “The Merck Manual” (See Link 4 below):
Red flags: The following findings are of particular concern:
  • Jaundice in the first day of life
  • TSB > 18 mg/dL
  • Rate of rise of TSB > 0.2 mg/dL/h (> 3.4 μmol/L/h) or > 5 mg/dL/day
  • Conjugated bilirubin concentration > 1 mg/dL (> 17 μmol/L) if TSB is < 5 mg/dL or > 20% of TSB (suggests neonatal cholestasis)
  • Jaundice after 2 wk of age
  • Lethargy, irritability, respiratory distress

Pathologic hyperbilirubinemia in term infants is diagnosed if
  • Jaundice appears in the first 24 h, after the first week of life, or lasts > 2 wk
  • Total serum bilirubin (TSB) rises by > 5 mg/dL/day
  • TSB is > 18 mg/dL
  • Infant shows symptoms or signs of a serious illness

Some of the most common pathologic causes are
  • Immune and nonimmune hemolytic anemia
  • G6PD deficiency
  • Hematoma resorption
  • Sepsis
  • Hypothyroidism
Links for additional reading:
 (1) US National Library of Medicine
(2) U of Iowa Info – with a CHART to help with evaluation of severity of jaundice
(3) Pediatrician’s Info – IN SUPPORT of breastfeeding
(4) The Merck Manual – Jaundice

The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
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4 Comments to Newborn jaundice:

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Jaci on Tuesday, November 08, 2011 1:29 PM
Very interesting. This is also something to talk to pediatricians about to see if everyone's on the same page. Our daughter's bilirubin levels were normal, but at her pediatrician check a week later we could tell she had jaundice just by looking at her skin and whites of her eyes (Physiologic jaundice is what it must have been as mentioned in your blog). She had it for weeks, even into her second month. I breastfed. Thankfully, our pediatrician acknowledged the jaundice along with her over all health and healthy weight gain (and bilirubin levels from the hospital) and told us not to worry, we'd keep an eye on it, but we didn't need to change anything we were doing and most importantly to continue breast feeding her. The jaundice cleared on its own, she's still healthy and happy and our pediatrician is still very satisfied with her health, jaundice was thankfully no big issue for us.
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Krystyna on Tuesday, November 08, 2011 1:58 PM
Jaci - thank you for your comment. It is a very good point to make sure that the pediatrician is on board. It is great to hear another positive story - thank you for sharing it. Would you have changed pediatricians if they didn't support your choice to breastfeed? Do you think your daughter may have had "breast milk jaundice"? They mentioned this on several sites. I didn't write about that today since it's usually late onset. This post addresses what parents might want to consider when they have a birth center or home birth to evaluate whether to seek additional care for jaundice; or for hospital birth parents to evaluate when they want to go home even if the baby is diagnosed with jaundice.

Laurie on Saturday, January 28, 2012 9:46 PM
A lot of moms I've talked to tell me that they were told to keep their mildly jaundiced babies near a sunny window or out in the sunshine to help rid their babies of jaundice. I know this might be a good way to help the baby rid its body of the extra bilirubin, but it really needs to be done with a lot of caution. Newborn's skin is extremely sensitive to sunburn, so they could be trading one evil for another (early burning is linked to skin cancer). Frequent feedings really is the best way to help a mild case of jaundice. Laurie - mom to nine former newborns
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First House Spouse on Saturday, November 16, 2013 4:46 AM
Three and a half weeks ago we had our son by unplanned c-section as well and suffered through jaundice for days. We shared the whole, daunting and detailed First Birth Story - Not According to Plan. Although everything was different than expected and overwhelming at the time, we are a stronger family from it and are simply happy to have our baby boy in the world :)
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