March 2012

Jaundice is the name given to a yellow discoloration of the skin and eye that occurs in infants, children, and adults. This coloration is caused by an excess amount of bilirubin (pronounced billy-roo-bin) in the skin and blood. Bilirubin is a yellow pigment and is normally found in small amounts in everyone’s body.

Bilirubin is created and released when red blood cells have broken down (red cells live about 120 days). Most babies have an excess of red blood cells at birth, and it is natural for the baby’s body to break down these excess cells. As more cells are destroyed, more bilirubin is created and eventually, unless it is excreted from the body, the level builds up and the skin assumes a yellow color. In older children and adults, this bilirubin is easily passed through the liver where it is processed and excreted from the body. In newborn infants, however, organs such as the liver are not fully developed, and processes are still active that result in an increased amount of bilirubin being recirculated to the liver. Both the immature liver, and the recirculation of bilirubin result in increased levels of bilirubin in the blood of most infants.

Occasionally there are other factors which will cause the baby’s red blood cells to break down more rapidly. The two most common conditions are called ABO incompatibility and Rh incompatibility. If the jaundice in your child is caused by either of these conditions, we will discuss it with you in more detail. Jaundice is usually seen around the second or third day of life. With some babies going home at less than forty eight hours of age, it is possible the jaundice will not show up prior to discharge. Therefore, if your infant leaves the hospital prior to forty eight hours of age, we will suggest that he/she be seen again at three to four days of age. If your baby should get very yellow or orange prior to or after his/her first office visit, call us.

The most common treatment for jaundice is with phototherapy lights or a “bili blanket”. The phototherapy light consists of a series of special fluorescent lights that are placed over the baby’s crib or basinette. The light results in a chemical reaction in the skin, which breaks down the bilirubin (photodecomposition). The broken down bilirubin is excreted by both the liver and kidneys. This light is generally used for several days depending on the results of the laboratory tests. During this time that he/she is under the light, his/her eyes will be covered with a mask to prevent eye damage from the bright light (this is not necessary with the bili blanket). His/her position will be changed frequently to assure that all areas are exposed to the light as much as possible.

Contrary to the well-intentioned suggestion of some, do not place your infant in sunlight in an attempt to bring down the bilirubin. Direct sunlight can quickly sunburn; sunlight filtered through glass still contains considerable amount of infrared and may seriously over heat your baby. There is no safe yet effective method of using sunlight to bring down the level of bilirubin. However, feeding breast milk or formula frequently is beneficial and highly recommended. Unfortunately, feeding water or glucose water is not helpful and there is very good evidence that water or glucose water feedings actually make the bilirubin level higher.

The phototherapy lights are well tolerated. Some children become fussy because they miss being wrapped up in their blankets, and others sleep contentedly. Occasionally, they will develop a skin rash which is temporary, and rarely will develop a greenish cast to the skin. Stools often become more frequent (this increases the excretion of the bilirubin) and become green in color.

Occasionally, readmission to the hospital is necessary to treat jaundice effectively. Very rarely, treatments in addition to phototherapy are indicated. If your child has a level of bilirubin that warrants consideration of other treatments, we will discuss them with you in detail.

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