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Newborn jaundice
Posted on November 8, 2011 at 2:58 PM |
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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 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 Note: 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. “BAR” 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:
Pathologic
hyperbilirubinemia in term infants is
diagnosed if
Some of the most common pathologic
causes are
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 Disclaimer: 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®. Winter Series December 5, 2011 to February 20, 2012 For more information or to register, please call us at 602-684-6567 or email us at [email protected] |
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