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Neonatal jaundice: What’s normal and what’s not

When should you worry about your infant's jaundice?

Imagine this: You are just wheeled out of the delivery room with your baby, all swaddled up and warm, you are reveling in the new found joys of motherhood, kind of settling in with the demands of the newborn breastfeeding and changing nappies and just as you feel you have touched the first milestone and established a real time bond with your baby, you learn that your baby is suffering from neonatal jaundice. Your heart skips a beat. Your doctor or the hospital staff assures you that it s not something you should worry about. As if their assurance wasn t enough your elders and other experienced mums tell you that they have gone through the same phase. This puts your mind to rest.

Know that neonatal jaundice or infantile jaundice is very common and happens to almost every newborn baby. The signs of neonatal jaundice are usually observed two or three days post birth of the baby, says Dr Santanu Sen, consultant pediatrician, Kokilaben Dhirubhai Ambani Hospital, Mumbai.

What is neonatal jaundice?

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Even though neonatal jaundice is a common occurrence, mothers should know that this is very different from the jaundice that an adult suffers from. Your baby doesn t suffer from the jaundice because of any liver failure but due to the presence of high level of bilirubin in the blood that the baby s immature liver isn t able to get rid of, says Dr Sen.

Bilirubin is a yellow substance that the body produces due to the breakdown of hemoglobin in the blood, when the body replaces the old red blood cells. This is a basic physiological phenomenon that takes place in the human body. The bilirubin produced in the process is then expelled out of the body by the liver. The liver enzymes break down bilirubin so that it can be removed from the body through stool and urine.

But in case of a newborn whose liver isn t matured enough, the bilirubin isn t tactfully expelled out of the body and makes its presence felt by making the baby look yellow under the skin and in the eyes, says Dr Sen.

How is this jaundice detected?

Neonatal jaundice shows up by making your baby look yellow on the face, the chest, and legs and also sometime on the soles of the feet. The mild form of jaundice might make your baby look just a bit pale yellow. A blood test is also done to check the bilirubin levels. If the bilirubin level is more than the normal levels for the babys age and weight, treatment may be required. says Dr Sen.

If a high level of bilirubin is seen further tests are done to check if there is any underlying problem. Higher levels of bilirubin can also raise a concern like if there is any mismatch in the blood group of the mother and baby. A blood test called the coomb s test is done to check on the blood group mismatch status, says Dr Sen.

The coomb s test is done to check whether the baby s blood has certain antibodies present in the blood serum. These antibodies attack the red blood cells breaking down the hemoglobin and leading to higher bilirubin content in the blood.

How is neonatal jaundice treated?

If the bilirubin level in your baby is high the treatment line might encompass

Phototherapy: Special blue lights are used on babies who have high level of bilirubin. An infant is placed under the artificial lights in an enclosed bed covering the genitals and the eyes. The therapy is continued for a day or two till your doctor is assured that your baby can be discharged and taken home safely.

Sunlight conjugation or sunlight therapy: Once the baby is discharged the parents are advised to continue with sunlight therapy for a few days to make sure all the bilirubin is expelled out of the body. Ideally you should spend an hour walking with your baby in the sun before 9 in the morning and after 4 in the evening to avoid the harsh rays. If you are planning to give a sun bath of sorts make sure you keep the genitals and the eyes covered, says Dr Sen.

The sunlight breaks down the bilirubin in the baby and makes it a water soluble substance that can be filtered by the kidney and removed from the systems through urine. The phototherapy at the hospital does the same with bilirubin.

Exchange transfusion: In case of severe jaundice an exchange transfusion of blood may be needed. In such case the transfusion is done by completely changing the entire blood of the baby till the high bilirubin levels are flushed out, informs Dr Sen.

Intravenous treatments: In some cases even severely jaundiced babies are treated with intravenous immunoglobulin in effectively reducing the bilirubin levels, says Dr Sen.

It is important to get your baby s bilirubin levels checked as higher levels can lead to serious complications like kernicterus, which is brain damage due to high levels of bilirubin. Hence if the bilirubin levels cannot be controlled with just phototherapy or sunlight, the other modalities of treatment may need to be considered, says Dr Sen.

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What you can do?

Don t panic: Remember neonatal jaundice is a common occurrence and almost all babies suffer from this. The infant s liver gets matured enough by seven to 10 days after birth when bilirubin can be managed by the body s own natural physiological processing, says Dr Sen.

Breastfeed often: Offer your baby enough feed to ensure proper hydration. Frequent feeds can also help the bilirubin to be flushed out through stool and urine, says Dr Sen.

Allow exposure to sunlight: Make sure you expose your baby to sunlight enough to get rid of bilirubin build up.

Know your Rh factor: It s important to get the Rh factor checked beforehand. If the mother is Rh ve steps can be taken to ensure fetal wellbeing so that a blood mismatch can be avoided.

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