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Newborn jaundice
| Posted on November 8, 2011 at 2:58 PM |
 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 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®.  Now enrolling for our 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] |
Categories: Birth plans, Breastfeeding, Childcare, Fussy baby, Homebirth, Hospital Birth, Information Center, Jaundice, Newborn Care, Newborn jaundice, Postpartum Plan
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387 Comments
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Jaci
8:29 PM on November 8, 2011
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.
Reply
Krystyna
8:58 PM on November 8, 2011
Jaci says...
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.
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.
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Laurie
4:46 AM on January 29, 2012
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
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
Reply
First House Spouse
11:46 AM on November 16, 2013
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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