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                   Jaundice

OVERVIEW:

      Jaundice is when the skin of the newborn appears to be yellow in color. Any jaundice that occurs within the first 24 hours should be checked by a doctor. This could indicate a more serious problem.

      Most jaundice will occur after the second day of life. Between day 2 to 5 is the most common time. The cause is from an increase amount of bilirubin in the baby. The baby is unable to process it fast enough, so becomes yellow form the excess.

      As long as baby is healthy, nursing effectively (10-12 times/24 hours and stooling 2-5 times a day) and not showing exaggerated levels of bilirubin, no treatment is necessary. The American Academy of Pediatrics suggests for Jaundice occurring at this point in the baby’s life that phototherapy be considered at bilirubin levels of 15 mg/dl, photo therapy be started at 18 mg/dl, exchange transfusion be done at 25 mg/dl and both exchange transfusion and intensive phototherapy are indicated at 30 mg/dl.

     Remember placing baby in in-direct sunlight will help the infants body process the bilirubin.

                                  Why Does My Baby Get Jaundice?

     Bilirubin passes thru the liver, and is excreted thru the bile and thru the intestines. Bilirubin is broken down in the liver but he newborn has a liver that is trying to keep up basically, and gets a little behind.  Newborns make more red blood cells than an adult and thus has a higher turnover rate of RBS’s  and if the liver is getting behind then a large amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool.

                                    WHY IS THIS IMPORTANT TO MY BABY?

      High levels of bilirubin in the newborn can cause deafness, cerebral palsy and mental retardation.

      What are the different kinds of jaundice? And How do we treat this?

Physiological (normal) jaundice: occurring in most newborns, this mild jaundice is due to the immaturity of the baby’s liver, which leads to a slow processing of bilirubin. It will appear at 2 to 4 days of age and disappears by 1 to 2 weeks of age.

Treatment: Nursing

       Jaundice of prematurity: This occurs in premature babies since they are even less ready to excrete bilirubin effectively. Jaundice in premature babies needs to be treated at a lower bilirubin level than in full term babies in order to avoid complications.

Treatment: breastfeeding and photo therapy is often done.

      Breastfeeding jaundice: jaundice can occur when a breastfeeding baby is not getting enough breast milk because of trouble with breastfeeding or because the mother’s milk isn’t in yet. This is not caused by a problem with the breast milk itself, but by the baby not getting enough to drink.

     Treatment: The way to take care of this is to nurse- nurse -nurse!

Breast milk jaundice: in about 1% to 2% of breastfed babies, jaundice may be caused by substances that is produced in the mother’s breast milk that can cause the bilirubin level to rise. This can prevent the excretion of bilirubin through the intestines. It starts after the first 3 to 5 days and slowly improves over 3 to 12 weeks.

    Treatment: Nursing still! Some doctors will take the baby off of breast milk until this improves.

    Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, and if the mother has produced antibodies-they can destroy the infant’s red blood cells.

    Treatment: sometimes your baby may need a blood transfusion.

                           Do We Need to Have Our Baby Tested?

     Well, I have seen babies that are so very yellow looking and be very high bilirubin and others very yellow not as high. I never judge how bad they are by how yellow they are. It is more safe to have the actual blood test done to be sure.

     What I do go by is how the baby is acting first. If the baby is not waking up easily to eat, is so very sleepy, and is not pooping then I worry about that baby more than the baby who is alert, awakens hungry and is pooping well. A baby that is moving the stool out of its body, will be able to continue to get rid of the bilirubin. This baby is not as sick of a baby as the one who is so sleepy, not alert, and not pooping. That sick baby needs to go see a medical doctor right away.

Can we do anything to prevent this from happening?

     Yes.  First of all, you need to nurse and nurse often.  You cannot over nurse! The colostrum is made special to help avoid jaundice, it acts as a laxative. If baby is pooping the black thick stool out, then the baby can continue to get rid of the bilirubin.

      I also suggest that you allow baby to be in the sunny window during the day, as the sunshine helps the body to break down the bilirubin.

                                     BREAST FEEDING SUPPLIES

     Well everyone usually asks can I use a breast shield or breast cups?  I personally do not like you to place anything on your breast except for the baby.  But if you have flat nipples (this is rare) then the following items may help.

Breast Cup 

      The center hole that covers your nipple is a bit smaller to place pressure on the nipple.

If you have sore nipples (usually from improper positioning the baby at the breast) the following items may provide some comfort to place in your bra.  The purpose of these are to keep the material off of your sore nipples so you do not have skin friction.  When you’re at home, you should not wear a bra, and if possible, pull the shades (if your windows are to the street!) and go around without a top on at all. Your nipples will heal easier and feel better to be exposed to air.

   This is often worn while the baby nurses..

    These are often worn in your bra to prevent the material from rubbing on the skin of sore nipples.