Hello there blog followers!

It is such a busy time of year isn’t it?  Christmas is literally 2 weeks away and I can hardly believe that the year is almost over!  I do love this time of  year in terms of being able to catch up with friends, have a few drinks, have the kids home from school (and less tired) as well as knowing that they get to have a break from all their extra-curricular activities… but MAN, is it exhausting or what?

Weekend just gone we caught up with my long-time friends and study group (the doctors that I studied with when training to become a paediatrician) and their families, and also had our new next door neighbours around for dinner for the first time.  This weekend, more catch ups with old friends who I haven’t seen all year, and school friend play dates for the kids.  I scarcely have time to blog!!  Good thing Uni is over for the year and I don’t have to do assignments and exams too!

Today I thought I’d blog on a topic that many of you parents out there will have had experience with.  As usual, I thought it would be a pretty quick topic to write about, but when I really sat down and gave it some thought, the article ended up longer than I expected.

So here t’is… hopefully this is enough information to keep you informed… but not too much to make you panic!  Remember if you are worried about this in your child, go and see your doctor!

 

What is jaundice?

Jaundice is when the baby’s skin and the whites of the eyes turn yellow because of a build up of a substance called bilirubin in those tissues. Bilirubin is a yellow coloured breakdown product (as waste product) that is made when red blood cells are broken down. Jaundice occurs when the body is not getting rid of the bilirubin efficiently (or quickly enough to keep up with the breakdown of red blood cells producing bilirubin).

Mild jaundice is actually pretty common in babies and in most cases it resolves without any need for intervention.

Normally, blood circulates to the liver and bilirubin is processed there then excreted into the bile that is squirted into the (small) intestine and eventually comes out in the faeces (poo). Some bilirubin also comes out in the urine (wee). When this happens as it should, bilirubin does not reach higher levels in the blood and so jaundice does not occur. This process can be disrupted for a number of reasons. There are several different types of jaundice in babies that result from different physiological processes. Some of these need medical intervention, and some don’t – depending on the cause and how severe it is.

 

Physiological jaundice

This is the most common form of jaundice in newborn babies, because they produce and breakdown a lot of red blood cells. Because their livers are immature and not fully developed and functioning to full capacity, the bilirubin can build up in the bloodstream. In most cases, within a week or two, the liver function catches up and the jaundice goes away on its own.

BreastMILK jaundice

Babies who are fed breastmilk can get what is called “breastmilk jaundice.” There are several different substances in the breastmilk that are thought to affect the baby’s ability to excrete the bilirubin (or increases its reabsorption from the gut). Typically breastmilk jaundice occurs in the second week of life, and can persist for up to 12 weeks before it eventually resolves on its own.

BreastFEEDING jaundice

This is not to be confused with breastMILK jaundice. BreastFEEDING jaundice occurs in breastfed infants where the baby is not getting enough breastmilk (due to a poor latch, weak suck or perhaps low maternal supply of breastmilk) and as a result, is not producing enough bowel motions and wee to excrete the bilirubin that builds up in the blood. It is usually resolved by increasing the frequency and/or duration of feeds or improving the latch of the baby to increase its intake.

 

There are lots of other causes of jaundice and although these are less common in occurrence, they more commonly need medical intervention. Some of these causes are:

1. Infection or sepsis
2. Cephalohaematoma (a collection of blood beneath the skin due to damage inflicted on blood vessels between the skull and inner layers of the skin during birth)
3. Haemolytic disease of the newborn
4. Blood group incompatibility, or rhesus disease (if your doctor thinks this might be a problem, for a specific type of blood incompatibility, an anti-D injection can be given immediately after delivery)
5. Hypothyroidism
6. Polycythaemia
7. Biliary atresia
8. Gut obstruction

Doctors look for several things to help them to decide whether or not jaundice is pathological (caused by disease as opposed to a normal physiological process that doesn’t need intervention) or not, and whether or not to start investigations (for example, other blood tests, ultrasound scans, liver biopsy) to find a cause or treatment. Some of these are:

1. Jaundice appearing in the first 24 hours of life or first appearing after the first 2 weeks of life.
2. Rapidly increasing bilirubin level.
3. Total bilirubin above a certain level
4. The TYPE of bilirubin that is present in the blood (yes, there is more than one type!)
5. The presence of other risk factors in the history can suggest a pathological cause to jaundice. Hence the doctor will likely ask you lots of questions relating to these things.       Some examples might be:
   1. Intrauterine growth restriction (baby that is much smaller than expected for its gestational age)
   2. Signs that might indicate an intrauterine infection (e.g. cataracts, small head, and enlargement of the liver and spleen)
   3. Cephalohematoma or other bruising
   4. Signs of bleeding in the brain’s ventricles.
   5. Family history of jaundice and anaemia or history of neonatal or early infant death due to liver disease,
   6. Maternal illness suggestive of viral infection (fever, rash or enlarged lymph nodes)
   7. History of maternal drugs/medications (e.g. sulphonamides, anti-malarials causing red blood cell destruction in G6PD deficiency).

Your doctor will be the one to decide if your baby needs further investigation or treatment regarding jaundice, but here are a few little pointers to help you know if you should be seeking medical attention:

1. If your baby is unwell, sleepy, not feeding well or failing to gain weight
2. If your baby’s bowel motions look pale or their urine becomes dark coloured.
3. If you can see that your baby looks yellow/jaundiced.
4. If your baby develops jaundice in the first 24 hours of life or after it is 2 weeks old
5. If you have had other children who have had jaundice needing treatment
6. If you and your baby have any of the risk factors listed above

TESTING for jaundice

Usually this is either by a blood test (in babies usually taken by a heel prick) or by using a machine called a bilirubinometer. If the level of bilirubin is too high, then other blood tests and investigations might be ordered to figure out the cause.

TREATMENT of jaundice in babies

The treatment of jaundice in a baby, really depends on how high the bilirubin level is, and what caused it in the first place.

Some babies just need monitoring and don’t need treatment at all (eg breastmilk jaundice). Others might need phototherapy (light therapy) for a few days. This can be done in a number of different ways – a “bili-blanket” which is a blanket that emits a blue light that is wrapped around the naked baby, or a phototherapy lamp placed over the baby’s cot. The baby’s eyes are covered during this treatment for protection from the light. Mostly, phototherapy is well tolerated by babies, but sometimes babies need extra feeds to make up for extra losses from evaporation from the skin.

In more severe cases of jaundice (usually caused by blood type incompatibility), the treatment for the baby is by replacing the baby’s own blood with compatible fresh blood. This is called “exchange transfusion.”

If your baby’s jaundice is caused by a surgical problem (like biliary atresia or a gut obstruction), then an urgent operation is usually needed to correct the issue.