Known as physiological jaundice, jaundice in newborns is quite normal and usually passes without complications.
It occurs when there is too much bilirubin or yellow pigment in the blood. When red blood cells are broken down, the waste product (bilirubin) is processed by the liver. When the liver can’t cope, the bilirubin is disposed of through the skin (the biggest organ in the body).
The baby’s face begins to look a bit yellow and this yellowing colour spreads to the chest and trunk. It disappears altogether 7 to 10 days later.
Although physiological jaundice is usually not problematic, it must be carefully watched; particularly if the baby is premature or small for dates. A warning sign is when the baby becomes floppy, lethargic, tired or too sleepy to feed. Babies who miss out on feeds can become hypoglycaemic (low blood sugar) and this can cause problems.
A subtle but significant cause of physiological jaundice is meconium reluctant to leave the baby’s intestines. This thick, dark green (almost black) mucus is baby’s first poo and is made up of bile, baby cells, hair and amniotic fluid swallowed during pregnancy. The bowel can be an excellent exit point for accumulated bilirubin, but this can’t happen if it’s blocked. The sooner the meconium is excreted the better – and the best way to do this is to breastfeed. Colostrum contains natural laxatives, so breastfeeding as soon as possible after birth initiates this cleaning out process.
In the next day or two when mature breast milk is delivered, this milk clearly absorbs bilirubin from the intestine. This can be seen when baby’s poo changes from dark green on the first day to transitional stools on day two and three (these are greenish brown) to golden-yellow, soft stools on day four. These stools have a high bilirubin content; and a new mother can be reassured that the jaundice is being “extracted.”
Some old wives' tales blame orange juice and other yellow fruits and vegetables for this yellow discolouration in babies. Your diet during pregnancy has nothing to do with baby jaundice. Beta-carotene found in dark green and yellow vegetables is an important part of your diet, so don’t leave them out.
If your baby becomes jaundiced in hospital your doctor will prescribe treatment that may include phototherapy lights if the levels are higher than 12 to 15. If you suspect jaundice after you leave the hospital, make sure that your baby feeds often and consult your doctor or local clinic.
Pathological jaundice is different. This type of jaundice is serious and warrants prompt medical attention.
It is usually noticeable within the first 24 hours after birth and can be the result of a number of causes, including blood-group incompatibility (usually the Rhesus factor which means that either mom or dad has a negative blood group), prematurity, or if the mother is diabetic. Drugs, a prolonged pregnancy, infections or polycythaemia (too many red blood cells in the baby) can also cause jaundice.
In pathological jaundice, the bilirubin rises quickly and steeply to dangerously high levels. In severe cases, bilirubin can cross the blood-brain barrier and deposits can stain the basal ganglia or grey matter of the brain, causing permanent damage. Your doctor will take blood tests early in your pregnancy to make sure that your blood group does not clash with that of your baby’s father.
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