Friday, August 13, 2010

What's with the Lights?

We hear a lot about jaundice in the newborn and wonder about the phototherapy treatment. About fifty percent of term newborns develop mild jaundice that causes a yellowing of the skin and whites of the eyes. It appears a few days after birth, peaks ( can look really almost orange ) and disappears around day twelve or so, two weeks. Premature babies develop it even more often.

It's most often about the immature liver's inability to handle the breakdown ( bilirubin ) of red cells, which happens normally to red cells. Your provider is the last word on testing and treatment. If the jaundice is significant, a heel stick is used to determine the amount of bilirubin present in the bloodstream. The treatment is phototherapy ( lights ) which are innocuous and present no discomfort or side affects.

In rarer instances the jaundice may be from infection that can be determined with a heel stick also. And infection is treated with antibiotics. A traumatic birth may bruise a baby significantly enough to cause jaundice. And certain maternal drugs may cause jaundice also.

Jaundice may be the result of blood incompatibilities: ABO incompatibilities and an Rh negative mom and Rh positive baby. Sometimes we hear of exchange transfusions to remedy this problem. Remember that we test for blood type and do antibody screens and inject Rhogam if necessary with bleeding, at 28 weeks and postpartum to avoid this cause of jaundice.

Very infrequently we hear of "breast milk" jaundice. It also presents at about five days and peaks around day ten. This jaundice is diagnosed by ruling out all other possible causes, stated above. This type of jaundice is thought to be the result of an interference with metabolism of bilirubin because of a substance sometimes rarely found in breast milk. In this case, breast feeding is discontinued for a day or two and then bilirubim levels are reevaluated. If they are significantly lower, we have our answer. If levels of bilirubin rise again, well then again breast feeding is stopped. Finally, bilirubin levels fall down and that's that, no other treatment is necessary. Pump to maintain milk supply while feeding formula to the infant and if you'd like you can freeze this milk to use later. Please remember it's not something that you ate or drank, in fact it's really not about you, but rather the fact that the baby just isn't quite ready to use breast milk YET.

Ultimately, the jaundice should not cause a long term concern. As with so many things with our infants, we report it, have it diagnosed and treated or "fixed" and that's that. Rather, it's not evaluating and dealing with the issue that may be a problem. So, you may be the first person to notice this yellowing of skin and the whites of eyes. Just report it to your doctor and let them take it from there.