Imagine this: You are just wheeled
out of the delivery room with your baby, all swaddled up and warm, you
are reveling in the new found joys of motherhood, kind of settling in
with the demands of the newborn – breastfeeding and changing nappies
–and just as you feel you have touched the first milestone and
established a real time bond with your baby, you learn that your baby is
suffering from neonatal jaundice. Your heart skips a beat. Your doctor
or the hospital staff assures you that it’s not something you should
worry about. As if their assurance wasn’t enough your elders and other
experienced mums tell you that they have gone through the same phase.
This puts your mind to rest.
Know that neonatal jaundice or
infantile jaundice is very common and happens to almost every newborn
baby. ‘The signs of neonatal jaundice are usually observed two or three
days post birth of the baby,’ says Dr Santanu Sen, consultant
pediatrician, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
What is neonatal jaundice?
‘Even though neonatal jaundice is a
common occurrence, mothers should know that this is very different from
the jaundice that an adult suffers from. Your baby doesn’t suffer from
the jaundice because of any liver failure but due to the presence of
high level of bilirubin in the blood that the baby’s immature liver
isn’t able to get rid of,’ says Dr Sen.
Bilirubin is a yellow substance that
the body produces due to the breakdown of hemoglobin in the blood, when
the body replaces the old red blood cells. This is a basic
physiological phenomenon that takes place in the human body. The
bilirubin produced in the process is then expelled out of the body by
the liver. The liver enzymes break down bilirubin so that it can be
removed from the body through stool and urine.
‘But in case of a newborn whose
liver isn’t matured enough, the bilirubin isn’t tactfully expelled out
of the body and makes its presence felt by making the baby look yellow
under the skin and in the eyes,’ says Dr Sen.
How is this jaundice detected?
Neonatal jaundice shows up by making
your baby look yellow on the face, the chest, and legs and also
sometime on the soles of the feet. The mild form of jaundice might make
your baby look just a bit pale yellow. ‘A blood test is also done to
check the bilirubin levels. If the bilirubin level is more than the
normal levels for the babys age and weight, treatment may be required.’
says Dr Sen.
If a high level of bilirubin is seen
further tests are done to check if there is any underlying problem.
‘Higher levels of bilirubin can also raise a concern like if there is
any mismatch in the blood group of the mother and baby. A blood test
called the coomb’s test is done to check on the blood group mismatch
status,’ says Dr Sen.
The coomb’s test is done to check
whether the baby’s blood has certain antibodies present in the blood
serum. These antibodies attack the red blood cells breaking down the
hemoglobin and leading to higher bilirubin content in the blood.
How is neonatal jaundice treated?
If the bilirubin level in your baby is high the treatment line might encompass
Phototherapy: Special blue
lights are used on babies who have high level of bilirubin. An infant is
placed under the artificial lights in an enclosed bed covering the
genitals and the eyes. The therapy is continued for a day or two till
your doctor is assured that your baby can be discharged and taken home
safely.
Sunlight conjugation or sunlight therapy:
‘Once the baby is discharged the parents are advised to continue with
sunlight therapy for a few days to make sure all the bilirubin is
expelled out of the body. Ideally you should spend an hour walking with
your baby in the sun before 9 in the morning and after 4 in the evening
to avoid the harsh rays. If you are planning to give a sun bath of sorts
make sure you keep the genitals and the eyes covered,’ says Dr Sen.
The sunlight breaks down the
bilirubin in the baby and makes it a water soluble substance that can be
filtered by the kidney and removed from the systems through urine. The
phototherapy at the hospital does the same with bilirubin.
Exchange transfusion: In case
of severe jaundice an exchange transfusion of blood may be needed. ‘In
such case the transfusion is done by completely changing the entire
blood of the baby till the high bilirubin levels are flushed out,’
informs Dr Sen.
Intravenous treatments:
‘In
some cases even severely jaundiced babies are treated with intravenous
immunoglobulin in effectively reducing the bilirubin levels,’ says Dr
Sen.
It is important to get your baby’s
bilirubin levels checked as higher levels can lead to serious
complications like kernicterus, which is brain damage due to high levels
of bilirubin. ‘Hence if the bilirubin levels cannot be controlled with
just phototherapy or sunlight, the other modalities of treatment may
need to be considered,’ says Dr Sen
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