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By Cecilia Koh
Jaundice is a symptom, not a disease and there are many reasons for it
happening. It is recognized primarily by the yellow discoloration of the skin.
In the womb, baby does not breathe but rely on a high level of red blood cells
to receive enough oxygen from the mother. After birth, the extra red cells are
broken down. One of the waste products is a substance called bilirubin which is
fat soluble (unconjugated bilirubin) that is, it dissolves in fat. This
bilirubin must be taken to the liver to be changed into water soluble bilirubin
(conjugated bilirubin) which is then passed out through the urine, stools and
sweat.
If for some reason the fat soluble bilirubin is not converted, it will attach
itself to fatty tissues that it comes into contact with, mainly in the skin and
brain. If too much bilirubin attaches itself to fatty tissues in the brain it
may cause brain damage.
Physiological jaundice is due to the above process and is the most common. It
usually appears on the 3rd day and disappears by 7th day. It is not dangerous as
long as the bilirubin level does not go up too high.
Early feeding after birth may reduce the prevalence of jaundice therefore try
putting baby to the breast in the delivery room. This also stimulates the breast
to start producing milk.
Other main causes of jaundice
Excessive bruising from a traumatic birth causes more than the usual amount of
red blood cells to be broken down, leading to higher levels of bilirubin to be
conjugated.
The preterm baby is more likely to become jaundiced because of an immature liver
which cannot cope with the high load of bilirubin.
G6PD deficiency is a condition where an enzyme necessary for the conjugation of
bilirubin is missing or insufficient.
Breast milk may interfere with the liver's ability to conjugate bilirubin
therefore the jaundice may be prolonged. Often, it is not necessary to stop
breast feeding but if the levels become too high, the paediatrician may
recommend stopping for a couple of days for the levels to come down.
Blood group and Rhesus incompatibility causes jaundice to appear during the
first 24 hours of life. It is important that all pregnant women go for prenatal
checkups in order to identify the possibility of this problem occurring, so that
preventive treatment for jaundice can be started fairly quickly after birth.
Prenatal infection of the mother such as rubella, syphilis, toxoplasmosis or
cytomegalovirus may cause jaundice in the newborn. After birth, any bacterial or
viral infection in the baby may cause jaundice.
How to check for jaundice and what to do
It is best to check for jaundice during the day using natural light. Hold the
baby near a door or window.
• Starting from the face, use your finger to gently but firmly press on the skin
and quickly let go.
• If the area that you pressed looks yellow the baby has jaundice
• Work your way down from the face to the legs.
If the yellow colour is only on the face then the jaundice is quite mild.
• Make sure that baby has sufficient fluids especially milk as it contains
glucose necessary for conjugation of bilirubin.
• Place the baby near a bright window during the day.
• It is not really necessary to put baby in the sun as baby may become over
heated by the sun's rays. Alternately, the baby may become chilled if there is a
strong wind blowing
• If you are breast feeding it is best that you do not take any ginger for the
first 10 days after delivery as ginger will make it harder for the liver to work
on the unconjugated bilirubin.
If the face and body are yellow, then the jaundice is quite high.
• You must take your baby back to the hospital immediately. Don't waste time
going to an outside clinic.
• Your baby needs a blood test to determine the bilirubin level and immediate
treatment if the level is high.
If at any time your baby is very sleepy and refuses to feed even if she looks
mildly jaundiced you must seek medical attention immediately.
Traditional treatment
There is NO place for traditional treatment. I have seen too many children with
permanent brain damage which is very sad as nowadays medical treatment is so
effective in preventing brain damage due to jaundice.
Bathing the baby in kunyit water is definitely not recommended because the skin
becomes more yellow in colour, therefore making it difficult to assess the true
jaundice level from looking at the skin. Do not give baby any herbal medicine as
it may interfere with the bilirubin conversion thereby increasing the levels of
fat soluble bilirubin and by the time the baby is taken to hospital, it may be
too late.
Medical treatment in hospital
Once your baby is admitted to hospital, the paediatrician will take some blood
to check the bilirubin levels which, together with the baby's age and general
condition will determine the need for further treatment.
Phototherapy is the use of fluorescent lights to break down bilirubin in the
skin making it water soluble which can be easily excreted. It can be given
continuously or intermittently at 3-4 hourly intervals. During phototherapy
treatment the baby is naked except for the nappy in order to expose as much of
the skin to the lights. The eyes are covered with eye pads to protect them. Baby
must be given extra fluids to prevent dehydration. It is normal if the baby
develops skin rashes and has loose green stools. Baby's bilirubin will be
monitored regularly during the treatment.
Exchange blood transfusion is done to remove the bilirubin and maternal
antibodies from the baby's circulation and replacing it with fresh blood from a
donor. It is normally done if the bilirubin level rises to a dangerous level
which cannot be reduced by phototherapy or there is severe Rhesus
incompatibility.
Remember if at any time you are not sure about your baby's jaundice always check
with the paediatrician.
Cecilia Koh is a British trained nurse/midwife with over 30 years working
experience. If you want to know more baby care topics go to
http://www.Babiesconsult.com |
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