Jaundice, or hyperbilirubinemia, is a common condition among newborns that can appear between the second and fourth day of life. It occurs because of high levels of bilirubin, a waste product of hemoglobin breakdown, present in blood and bile. The fully formed liver can filter and eliminate it, but the immature organ of newborns cannot. In this way, the baby can turn yellow. Although there is no correct way to prevent the condition, know the risk factors to know what to do to avoid it and take care of your child if applicable.
Part 1 of 3: Assessing and Controlling Risk Factors
Step 1. Take blood tests during pregnancy
Certain blood incompatibilities can induce hemoglobin degradation, producing more bilirubin.
- Pregnant women with negative Rh factor or O+ blood should be more attentive to blood tests, as the Rh positive factor of the fetus and the incompatibility of the ABO system are the biggest risk factors.
- Some genetic deficiencies, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency, also increase the risk of jaundice, as the condition causes red blood cell destruction, increasing bilirubin in the bloodstream.
- In addition to prenatal care, doctors now also examine newborns for jaundice before the baby leaves the hospital.
Step 2. Decrease the chance of a premature birth
Babies born before the 38th week are more likely to develop jaundice. A premature's liver is less developed, having more difficulty eliminating bilirubin.
- Some risk factors cannot be changed, such as the mother's age or multiple pregnancy, but environmental ones can.
- Perform all prenatal exams. Prenatal care done early and consistently can ensure the health of the mother and baby during pregnancy, identifying in advance any problem that causes a premature birth.
- Avoid chemical contaminants. Cigarettes, alcohol, other drugs and some medications can increase the chances of a premature birth. If you need help quitting an addiction, talk to your doctor. Environmental pollution can also increase this risk.
- Stay calm. Stress is one of the factors that most influence premature births. Lack of social support, work that requires physical or emotional effort, and domestic violence (physical or emotional) can contribute to increased stress and lead to premature birth.
- Monitor or decrease your risk of developing certain infections. Infections such as herpes, syphilis, cytomegalovirus and toxoplasmosis can lead to premature births and jaundice.
Step 3. Know that a breastfed baby is more likely to develop jaundice
However, this form of the condition is easy to treat and lasts for a short time.
- Breast milk only starts to be produced a few days after delivery. In the first days of life, the baby sucks what we call colostrum, a very thin substance, but very rich in nutrients.
- Depending on the components of breast milk, the newborn may not breastfeed satisfactorily. Thus, his digestive system works more slowly and does not excrete all the bilirubin produced in the body. In general, this problem poses no health risk. Experts continue to recommend breastfeeding.
- Only in some cases the doctor can guide the suspension of breastfeeding, which should be temporary.
Part 2 of 3: Treating Newborn Jaundice
Step 1. Start breastfeeding right away
Breastfeeding soon after birth can reduce the risk of jaundice and even start treating it if the problem is already present.
- Success rates increase when breastfeeding begins within the first few hours after delivery. Weight gain can help the newborn to develop faster, which improves liver function.
- In addition, the colostrum produced by the mother early on causes the baby's digestive system to eliminate waste, excreting excess bilirubin from the intestine. That is, the sooner the baby starts pooping, the sooner the jaundice will go away.
- Talk to the obstetrician about breastfeeding to learn the right techniques. This professional helps first-time moms understand how to encourage the baby to make the right attachment and get the right breastfeed.
Step 2. Feed the baby often
Milk increases weight gain and helps the child's development, including the liver. This goes for breastfed or formula-fed babies. Ideally, newborns should breastfeed 8 to 12 times a day for the first few days of life, especially if they are at risk of developing jaundice.
If you breastfeed, be aware that frequent feedings in the first days of life (8 to 12 a day) stimulate milk production earlier, thus feeding the baby better
Step 3. Treat him with phototherapy at the hospital
Ultraviolet light alters the molecules of bilirubin, eliminating the need for it to be broken down in the liver to be excreted.
- If recommended by the doctor, expose the baby unclothed or only in a diaper to sunlight for a little more than five minutes, once or twice a day. Do not exceed this time, as prolonged exposure can cause skin burns and additional complications. Take care so that he doesn't get cold at this time: increase the temperature of the room or put him on your chest while sunbathing.
- Another alternative is to position the baby's crib in a sunny location with curtains on the window. Window glass and curtains filter out most of the UV rays that can cause skin problems, allowing him to sunbathe without getting burned.
Part 3 of 3: Understanding jaundice
Step 1. Know how jaundice develops
It usually appears on the second or third day of life and almost always follows a predictable pattern.
- In a healthy body, bilirubin is a natural by-product found in the bloodstream from the breakdown of red blood cells. It reaches the liver, where it is excreted through the bile duct and feces. The liver of a newborn with jaundice does not yet function effectively, so bilirubin builds up in the liver and blood rather than being eliminated.
- Hospitals usually do tests for neonatal jaundice, as it is very common – around 60% of babies born at term have the problem, an even higher number among premature babies. In general, the level of bilirubin is checked by a blood test taken with a heel prick.
- Below 5 mg per deciliter (mg/dL), the bilirubin level is considered normal. Above that, it's already high.
- Most babies with mild to moderate jaundice do not need treatment as it goes away on its own after a week or two.
- If the level is too high, rises quickly and does not fall after two weeks, phototherapy is usually recommended (the baby is exposed to UV rays, a harmless treatment suitable for most cases).
- In rare cases, a blood transfusion may be needed to control severe jaundice.
Step 2. Know the symptoms
Testing blood bilirubin levels is essential in suspected cases, but it is sometimes possible to detect jaundice through the symptoms:
- The skin and whites of the eyes turn yellow. This is the most common symptom.
- There is drowsiness and difficulty in nursing. Sometimes, too much bilirubin can make the newborn sleepy, making it difficult to feed. A trick to get him to breastfeed under these conditions is to take off the baby's clothes.
Step 3. Know when jaundice is a problem
As already stated, this is a very common condition that often resolves on its own. However, in rare cases, it can cause complications and require treatment.
- If bilirubin levels are high and nothing is done (generating a case of "severe hyperbilirubinemia"), it can migrate to the brain, causing serious complications.
- Although rare, these complications cause permanent brain damage (cerebral palsy, learning problems or disabilities), affect tooth enamel production, or lead to hearing loss.
- Look out for symptoms such as lethargy, intense yellowing on the skin and feet (especially on the soles). Also, the baby may have hypotonia, fever or irritation and cry.
- Your doctor may recommend that breast milk be supplemented with formula if your bilirubin level continues to rise after a few days. In most cases, this measure is not necessary unless the baby is above 20 mg/dL or the baby has other risk factors for jaundice due to premature birth, blood disorders or weight loss. Formula supplementation can make it difficult to breastfeed later. Talk to your doctor about the pros and cons before offering a bottle.
- Since most have jaundice, it's a good idea to avoid yellow clothing in your newborn. The color may reflect on the child's skin and eyes, making it difficult to identify the sign.
- If the baby is black, look at his gums and eyes.
- Never give water to a newborn. Even if you mean well and think water can help, be aware that it can be fatal by interfering with the delicate balance of nutrients in the bloodstream.
- Seek immediate medical attention if you notice the baby is lethargic, has yellowed skin or soles, is not breastfeeding properly, or appears dehydrated.