What is Jaundice?

If you are a new parent and are told your baby has jaundice it is often very frightening.  In all actuality jaundice is relatively common condition that doctors see every day. While doctors might see this every day, it still can be alarming to parents who want to know as much as they can about this ailment.

 What is Jaundice?  Jaundice is when your baby’s skin takes on a yellow pigment called bilirubium. Most babies with Jaundice are diagnosed as normal, or physiologic. While physiologic jaundices sounds more serious it is important to know it is not a disease – it is for the most part harmless.  Jaundice occurs when there is too much bilirubin being produced for the liver to remove from the blood.   Jaundice may also occur when there is a defect in the liver that prevents bilirubin from being removed from the blood.  It also could occur if there is a blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines.

What are some ways to detect Jaundice?

·         Check the face first.  You can also check the chest, abdomen, arms.

·         The proper way to check is by pressing one finger on your baby's forehead or nose. If the skin is jaundiced, it will appear yellow when you release pressure from the skin.

Before babies are born, they need high levels of red blood cells in order to get oxygen from their mother’s blood.  Immediately after birth, when they begin breathing high-oxygen blood outside the womb, they no longer need their fetal hemoglobin.  The red blood cells containing fetal hemoglobin now need to be broken down and eliminated from their bodies.  Bilirubin is a by-product of the breakdown of these extra blood cells, and is removed from the bloodstream by the liver and excreted in the stool.  The newborn’s immature liver may not be able to process and excrete the bilirubin fast enough in the first days after birth, so jaundice often develops.  This is especially common in premature infants. 

 The average full-term newborn will have a peak level of 6mg/dl on the third or fourth day of life. Levels usually go down to about 2-3mg/dl by the end of the first week, gradually reaching the adult value of 1mg/dl by the end of the second week.  It usually takes the newborn’s liver a week or two to mature enough to handle the build-up of bilirubin in the blood.  It is important to know that there is no evidence that bilirubin levels of less than 20mg/dl during the first week of life, and less than 25mg/sl after that have any harmful effects of healthy, full-term babies.

 So, if jaundice is such a normal condition, why is there any concern?  Because there are rare medical conditions which cause bilirubin to rise to dangerous levels, and can cause brain damage.  Years ago, before we had the diagnostic tools and treatment options that we have today, some babies with very high bilirubin levels suffered from a condition called bilirubin encephalopathy, or kernicterus.  This is rarely seen today, and then usually only in very premature or sick babies.  Doctors today monitor bilirubin levels very carefully, and initiate treatment well before levels get high enough to cause problems.

 You should understand that there are three types of jaundice:  The first type is called Normal Jaundice, sometimes referred to as physiologic jaundice.  This type is called Normal because it is the type of Jaundice that affects the majority of newborns.  The second type of Jaundice is Pathologic Jaundice.  It is more serious and is caused by medical conditions such as blood type incompatibilities (the most common cause), as well as prematurity, infection, liver damage from rubella, syphllis, or toxoplasmosis, and metabolic problems such as hypothyroidism.  The last type of Jaundice is known as Breastmilk Jaundice.  The name says it all, as this Jaundice is typically brought on through breast feeding.