Jaundice, or yellowing of a newborn’s skin, is a common occurrence in the newborn period but is one of those first health concerns that parents worry about. Neonatal jaundice is the build-up of bilirubin in the body. Bilirubin is a toxin that is filtered out by the liver, the main filter of the body that filters many toxins. At birth, the liver is often slow to activate causing a back-up in this filtering process. This then causes the bilirubin to collect in other organs. The most obvious symptom is the hallmark yellowing of the skin which in itself is not harmful but when this same toxin collects in the brain, there can be problems. In rare cases, high levels of bilirubin in the brain can lead to kernicterus, a serious neurological disorder.
Fortunately as the baby ages, the barrier that keeps the bilirubin out of the brain gets tougher. Every day this barrier improves making it harder and harder for levels in the brain to become dangerous. Thus the concerning level of bilirubin on day one is much different than the level on day four.
Bilirubin is naturally made by the body but certain things can increase this level. These include bruising at birth or a mismatch between mom and baby’s blood. Bilirubin also goes up if the filter (liver) is slow to activate. Eating triggers the liver to activate. A delay in eating caused by a lack of breast milk production, C-section birth, or diabetes in the mother will slow down the filtering process increasing the jaundice.
Treatment for jaundice is directed first at increasing what the baby is eating – simply feeding more often or for longer periods of time. Once the baby eats more, the liver can process the bilirubin and eliminate it from the body through urination and stooling. For this reason your doctor may have breast feeding moms add supplemental formula to reduce the jaundice level. This may continue for several days until the concern for elevated bilirubin has passed. Thankfully as the bilirubin improves, the baby’s feeding and nursing gets much easier.
In more severe cases, when the bilirubin level is rising too quickly and approaching a more dangerous level, more treatment may be necessary usually starting with phototherapy. Baby lies under a blue light which changes the bilirubin collected in the skin into a form that can be eliminated by the body without needing to be processed by the liver. Sometimes fluid given by an IV is also necessary.
Jaundice can add stress to an already stressful time during the newborn period, but with some relatively simple steps the majority of jaundice is short-lived with no lasting effects.