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Understanding Jaundice in Newborns

Jaundice is a condition that develops within the first week after baby is born. This is the reason why most healthcare providers request a check with baby before the first well baby check at two weeks.

Jaundice is characterized by a yellowish tint to the skin and whites of the eyes. While baby’s appearance can be a bit alarming to a new mother, it is important to remember that jaundice is part of a natural body process.

Jaundice is extremely common in newborns. In fact, half of all healthy babies will develop the condition. Breastfed babies are more likely to develop the condition, as are preemies, of whom eighty percent will be affected by the condition.

While jaundice generally passes without any necessary treatment, there are lifelong complications that can result from prolonged exposure to high bilirubin levels.

If you notice signs of jaundice, it is extremely important that you contact your health care provider immediately, in order to avoid complications.

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7 What Causes Jaundice?

Newborn babies have an excessive amount of red blood cells at birth, almost as many as adults. As baby’s immature liver begins to break down these red blood cells, it produces bilirubin, a yellow pigment that tints the whites of the eyes and the skin.

Parents first notice a yellow tinge to the whites of the eyes and baby’s skin between two to four days after birth.Bilirubin levels generally peak by day seven, and gradually lowers to normal levels before baby is two weeks old.

This is a normal body process, and is called physiological jaundice. This is the most common type of jaundice in newborns, and there are usually no lasting effects.

Jaundice can be more serious if any of the following are present:

  • onset is within 24 hours of baby’s birth
  • baby is not eating well
  • baby is irritable
  • extremely high bilirubin levels
  • jaundice lasts for more than two weeks
  • pale colored stool
  • extremely dark urine

Non Physiological Jaundice

Non physiological jaundice an extremely rare occurrence. The term “non physiological” refers to the fact that this type of jaundice is not part of a normal body process. In fact, it is caused by illness or a health issue.

This type of jaundice makes it’s appearance before baby is twenty four hours old, or after two weeks. Non physiological jaundice can develop into a severe health issue, and medical treatment is generally necessary.

Some causes of non physiological jaundice are:

  • severe infection, usually meningitis, a blood infection or urine infection
  • abnormalities of the bowel, gallbladder, or liver
  • twin to twin transfusion, a condition where twins share a blood supply via one placenta, this can cause one twin to receive too much blood, while the other twin doesn’t receive enough blood
  • baby’s blood is incompatible with the mother’s
  • babies with toxoplasmosis, rubella, cytomegalovirus, or listeriosis
  • babies with a genetic metabolic disorder

6 Is There a Link Between Newborn Vitamin K Injections and Jaundice?

Since 1944, American babies have been given a shot of vitamin K shortly after birth to help prevent the occurrence of an extremely rare disorder known as, Hemorrhagic Disease of the Newborn, or HDN.

In untreated babies, the instance of this disease is less than one percent in healthy infants.While certain risk factors may indicate that a greater risk for HDN is present, most newborns are not at a high risk for the disease.

Your infant is at risk of HDN if the following circumstances are present:

  • use of certain medications by the mother during pregnancy
  • prolonged labor and delivery
  • extremely fast labor and delivery
  • c - section birth
  • premature birth
  • forceps delivery

Another reason healthcare providers give the vitamin K shot, is to prevent excess bleeding during circumcision.

The injections given at birth contain twenty thousand times the amount of vitamin K that a newborn requires.

The National Institutes of Health warns, “ Hemolysis, jaundice, and hyperbilirubinemia in neonates, particularly those that are premature, may be related to the dose of Vitamin K1 Injection. Therefore, the recommended dose should not be exceeded.”

Does this mean that there is a causal link between hyperbilirubinemia, or jaundice, and the vitamin K shot? Taking into consideration that newborns are injected with twenty thousand times the amount of vitamin K that they need, a causal link becomes highly probable.

The National Institutes of Health goes on to say, ” Hyperbilirubinemia has been observed in the newborn following administration of phytonadione. This has occurred rarely and primarily with doses above those recommended.”

After these statements made by one of the Nation’s leading health agencies, it goes to reason that there is most definitely a causal link between the vitamin K shots our newborns routinely receive and jaundice.

Alternatives to the Vitamin K Shot

For parents who choose to avoid the risks associated with the vitamin K shot, there are safe alternatives.

Colostrum is extremely rich in Vitamin K , and has been shown to raise baby’s vitamin K levels naturally. The vitamin K in colostrum is absorbed by the gut, versus an intramuscular injection of synthetic vitamin k. Receiving vitamin K through the gut is the way the body naturally absorbs vitamin K, therefore, the vitamin K in colostrum is easily assimilated by a fragile newborn.

5 Breastfeeding and Jaundice

Breastfed babies generally have slightly higher bilirubin levels than bottle fed babies, 14.8 mg versus 12.2 mg. Researchers believe that this is because of an undiscovered factor that is present in breast milk that sends bilirubin into the bloodstream, instead of routing it on the baby’s immature liver to be processed.

Jaundice levels in breastfed newborns may be elevated due to lower levels of milk consumption, due to infrequent feeding. Feeding infants on demand versus the scheduled feedings that are promoted by most healthcare providers could possibly even the playing field between breast and bottle feeding.

Another culprit of the lower milk levels that are consumed by breastfed newborns, is a lack of knowledge on the part of the mother. Correct positioning and latching techniques are crucial in the early days to ensure that baby gets the nutrition he or she needs.

Because breastfeeding fell out of vogue in decades past, women lack the practical knowledge that successful breastfeeding requires. This is why many hospitals employ lactation consultants, and have breastfeeding classes as part of their prenatal education programs.

Another option is to consult with The La Leche League for education and advice from experienced breastfeeding mothers. Most cities have a local support group that can be an excellent resource for new mothers.

If your healthcare provider suggests formula supplementation to help increase the volume of milk baby is getting, ask if you could attempt to increase the volume on your own with more frequent feedings, or feed baby donor breast milk as a supplement.

For the most part, jaundice will resolve itself on it’s own without any treatment. Traditional methods of treatment for jaundice do not facilitate successful breastfeeding. As long as your baby is otherwise healthy, jaundice is not a cause for alarm. If baby does have health issues causing jaundice, your breastmilk is invaluable nutrition to help baby have the best outcome possible.

4 Symptoms of Jaundice

Yellowing of the skin and the whites of the eyes are common symptoms of neonatal jaundice. As the disorder progresses, the yellow tint to the skin will spread down to baby’s midsection. You may also notice extreme sleepiness and high pitched screaming in a baby who has a more advanced case, as all of these are indicative of higher bilirubin levels.

An easy way to tell if your baby is jaundiced is to lightly press on baby’s nose or forehead. The skin should look lighter than normal where it’s been pressed. If a yellow tinge is present, chances are, your baby has jaundice. If this is the case, please contact your health professional for further instructions.

Diagnosis

An initial diagnosis of jaundice will probably be made by your healthcare provider based upon baby’s physical symptoms. Further testing will be necessary to determine the level of bilirubin in baby’s blood, so that accurate treatment can be prescribed.

Some of the tests your doctor may perform are:

  • a heel stick blood test
  • thorough physical examination
  • a simple skin test with a transcutaneous bilirubinometer to determine the level of baby’s jaundice
  • blood, urine, or other tests if baby’s jaundice is determined to be caused by an existing disorder

3 Treatment

The treatment plan for your baby’s jaundice will depend on how severe his or her condition is, and whether or not your baby has an underlying disorder that is causing your baby to become jaundiced.

At Home Treatment

If jaundice is not severe, you may be asked to increase the amount of feeding baby is receiving. Remember that for the first week of life, newborns need between eight and twelve feedings a day.

This may sound like a lot, but it is necessary to help baby’s body rid itself of bilirubin, and establish good breastfeeding habits.

Your doctor may ask you to supplement baby’s feedings if you are breastfeeding. Again, avoid formula if possible. Donor milk or expressed milk should be used in order to keep the milk supply up. Supplementing with formula can have disastrous effects on an otherwise great nursing relationship.

Exposing baby to indirect sunlight as much as possible can help rid the body of bilirubin as well.

2 Medical Treatment

In more severe cases of jaundice, or if an underlying disorder is present, medical treatment may become necessary.

Phototherapy is the most common form of therapy for jaundice. Treatment is given with a bili light or bili blanket.

Phototherapy uses light to help the baby’s body to eliminate bilirubin from the blood. The light waves pass through baby’s skin and blood help the liver to process the bilirubin more effectively.

Biliblankets are commonly used by healthcare professionals because they can offer at home medical treatment for jaundice. A woven ad containing a light is secured around baby’s mid section, directly on the skin, to bathe the skin in fiberoptic light.

Baby can be diapered, and fed while wrapped in a biliblanket. This makes it a perfect choice for nursing mothers who have concerns about treatment interfering with breastfeedings.

When these blankets are used at home, frequent blood tests are administered to measure bilirubin levels in baby’s blood in order to determine if further treatment is necessary.

It is imperative to use the biliblanket for the amount of time per day that is recommended by your healthcare provider for optimal results.

If necessary, baby may be placed under a bili light. Baby will be fully naked, and wear protective eyewear to prevent damage to baby’s delicate eyes. This treatment must be performed in the hospital, under close supervision.

Rarely, a blood transfusion may be required to lower extremely high bilirubin levels as a last resort. 

1 Long Term Effects

Parents of newborns who have had jaundice often wonder whether or not their child will suffer any long term effects from the condition.

A recent study from the New England Journal of Medicine states that the majority of all children who develop jaundice will not have any ill effects from the condition.

The study monitored children for five years who had received treatment for jaundice, two of them had what was considered severe jaundice. The researchers found no difference in the IQ and development of babies who had been diagnosed with jaundice versus their peers who had not had the condition.

The researchers did feel that it was important for parents to monitor their newborns in their early days for development of the condition.

Prevention

There are no sure fire ways to prevent jaundice, but these tips can help minimize your baby’s risks of having it:

  • nurse baby 8 - 12 times in the first few weeks
  • make sure you are informed about the vitamin K shot before you give birth
  • if your doctor recommends supplementation, consider using donor milk
  • place baby in indirect sunlight to help his or her body process excess bilirubin

Jaundice in newborns is very common, but needs to be monitored by your healthcare provider. If your newborn shows signs and symptoms of jaundice, contact your health care provider immediately.

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