Bilirubin is a pigment in blood that causes neonatal hyperbilirubinemia, jaundice, in newborns. This happens when the red blood cells break down. The pigment is orange-yellow, and excessive levels can cause the skin and/or eyes to appear yellowed, this is referred to as jaundice. Normally the liver removes the bilirubin from your baby’s blood and excretes it through the initial stools, or meconium. High bilirubin levels can be caused by two key things: blood breaking down at a faster than normal rate or by a liver that isn’t functioning properly. High bilirubin levels in adults can be a sign of cirrhosis, hepatitis, gallstones, or sickle cell disease.
A high level of bilirubin is common in newborns, and, as long as it passes within approximately two to three weeks, it is not a concern or indicator of another disease. The most common reason, known as physiological jaundice, for high bilirubin levels in newborns is that it can take some time for the baby’s liver to adjust to taking over the bilirubin-removal job from the placenta. Jaundice is more common in breastfed babies; this can occur when the mother’s milk doesn’t come in right away or if the baby is having trouble nursing – this is referred to as breastfeeding jaundice. Another, less common type of newborn jaundice is breast milk jaundice. This may occur after the first week and peak between two to three weeks. Breast milk jaundice could be because a substance in the breastmilk may affect how the liver breaks down the bilirubin. Other possible causes of jaundice in newborns are sickle cell anemia, Rh incompatibility, cephalohematoma (bleeding under the scalp which can be caused by a difficult birth), or infection. Premature babies are also more likely to develop jaundice.
Before leaving the hospital, usually at 24-hours, they will perform a blood draw on your baby through a heel-stick. A heel-stick is where they prick the skin on your baby’s heel and then pinch the foot to cause the blood to drip out. A newborn with jaundice will have yellowed-skin, and if severe they will have yellowed eyes and may be tired and have trouble eating. If your pediatrician is concerned with possible jaundice at your baby’s 2-day appointment she will use a forehead probe, or wand, to test their bilirubin levels. If the levels are high they will order a blood test to get an exact number and determine if treatment is necessary.
Treatment for newborn jaundice is typically not needed. Babies with jaundice should eat often to encourage more stools which will help their body pass the bilirubin. Exposure to natural light, the sun, can also help reduce jaundice. If your newborn has a higher than normal level or a level that is rising quickly, then your baby will likely need treatment. Treatment may involve IV fluids and/or phototherapy. Newborn phototherapy is done with blue lights. Your baby will be wearing only a diaper and an eye cover to protect their eyes, and they will be kept under a warmer. Some hospitals allow the phototherapy to occur while the baby is held skin-to-skin and/or even nursing – ask your hospital if this is an option. In extreme cases, your baby may need a transfusion to help replace the damaged cells with healthy red blood cells, and increase their red blood cell count. Sometimes, with less severe cases, you can do phototherapy at home with a fiber-optic blanket.
Did your baby have jaundice? Did it resolve on its own or need treatment? Both of my babies have had mild cases of jaundice that resolved on their own with lots of nursing.
Next week I will be blogging on the letter C… C is for Cradle Cap.