Fear - our jaundice scare

He stayed there a nail-biting scary 3 days.
It was my first emergency with my first child.
I have never felt so helpless.
I treasured Brandon even more than I already did.
God was on my side...

Jaundice Information

     Jaundice occurs in about 60% of healthy term infants and 80% of those born early. Bilirubin, the yellow pigment responsible for jaundice, is a normal component in the breakdown of hemoglobin, the red pigment in red blood cells. Every day, about 1% of our red blood cells expire, to be replaced by fresh, young ones ready to carry oxygen to supply the body. A low level of bilirubin (about 1 mg/dL) circulates throughout our bodies as part of this process. In most cases, bilirubin is detoxified by the liver and excreted by the kidneys. Before babies are born, this renewing of the blood occurs using the placenta to carry away the bilirubin as it is formed. But once the baby is born, a baby's liver is often so immature that the excess bilirubin produces jaundice, a yellow discoloration of the baby's skin, mucus membranes, and the whites of the eyes.

     The most common type of jaundice is called physiologic jaundice, the normal increased bilirubin in babies whose livers can't quite keep up with a slightly increased load of red blood cells. This jaundice usually becomes visible on day 2 or 3 and peaks somewhere between days 2 and 4 as the liver gains control of the situation. The bilirubin levels usually have fallen substantially by day 7. Sometimes they reach a level at which treatment is needed (>15 mg/dL before 48 hours old, >18 mg/dL before 72 hours old, > 20 mg/dL anytime--in otherwise healthy term babies). Stopping nursing is not recommended for physiologic jaundice, although supplementing feeds with pumped breast milk or formula may be helpful.

     Breast-feeding jaundice is far less common, occurring in about 1 in 200 babies. Here the jaundice is often not visible until the baby is a week old and then reaches its peak during the second or third week. Breast-feeding jaundice can be caused either by enzymes in mom's milk that deactivate the baby's enzyme for dealing with bilirubin or by fatty acids in mom's milk that the baby processes as a priority over processing the bilirubin.

     Whichever the cause, if the mother continues to nurse her baby, the jaundice will decrease and disappear on its own, but this may take 3 to 10 weeks. If the mother stops nursing for 1 or 2 days, substituting formula, the bilirubin levels will drop rapidly. They will not rise again when the nursing is resumed.

     If the bilirubin reaches a high level, your doctor may recommend that you place your baby under a special light. While breast feeding might prolong jaundice, jaundice isn't always a signal to stop nursing.

     But don't ignore a high bilirubin level either. Bilirubin is found throughout the body, not just in the skin. Under certain conditions, high concentrations of bilirubin are toxic to babies' brains. This is very rare when the concentration is under 25 mg/dL, but at higher concentrations, an increased risk for permanent hearing loss, mental retardation, spastic quadriplegia, or even death exists. It can cause irreversible brain damage. That's why your doctor will monitor your baby to determine if the jaundice is normal or more serious. More serious forms of jaundice usually occur within 24 hours of the birth and can be due to blood type incompatibility or Rh factor incompatibility.

     If the bilirubin concentration rises to about 5 mg/dL, the face takes on a yellow appearance. If the level reaches about 15 mg/dL, the yellow tint is visible from the head down to the midabdomen. At a level of 20 mg/dL, even the soles of the feet are yellow (note: these are approximations; a blood test is required to know the bilirubin level).

     Anything that increases the number of red blood cells expiring soon after birth makes jaundice more likely. This might include the pounding babies take during difficult births or the scalp hematomas caused by vacuum-assisted deliveries, blood-type incompatibility, delayed cord clamping, a congenital anemia, or an infection.

     Anything that makes it tougher for the immature liver to process the bilirubin can also lead to jaundice, including prematurity, lack of oxygen, poor feeding, thyroid deficiency, a genetic enzyme deficiency, or a liver otherwise occupied with dealing with an infection or a drug (such as oxytocin with chlorobutanol [Pitocin]).