Understanding Neonatal Jaundice

Hyper Billy Reuben what? John Dust who? Confusion often strikes when these terms are thrown out to parents as the big blue lights and masks are being placed upon their baby. If you’re like many preemie parents you’re given an explanation of this condition that is never extremely clear. You are told that this is a normal abnormal in even most term babies but premature babies almost always get it.

Get it?

how do they get it? What is it? Can it be cured?

Jaundice or even more medically termed, hyperbilirubinemia is the cause of the yellowing of the skin and sometimes the whites of the eyes. Up to 90% of newborns will develop some degree of jaundice within the first week of life, and almost all premature babies will begin to show signs during the first few days. It is a common and very treatable condition and seldom results in long-term complications.

What is it? Bilirubin is the byproduct of the body’s recycling of red blood cells. As the excess red blood in the infant’s circulation begins to breakdown in the first few days after birth, they release what is called bilirubin, which causes the yellowish coloring of the skin and eyes. Bilirubin is normally processed by the liver and excreted in the stool. Bilirubin levels in premature infants are often higher because preemies cannot break down their red blood cells as fast as a term baby and their immature livers cannot excrete the bilirubin as quickly as full-term infants can.

This becomes a problem because high levels of bilirubin become toxic to the baby’s nervous system. A premature baby’s nervous system is more vulnerable to the toxic effects of bilirubin, so it is important that these levels are closely monitored, especially in the first days of life.

Moderate increases in bilirubin levels are common and may not be harmful to the baby.

But if the levels circulating in the bloodstream get too high, they may enter into the brain and could cause damage. If the levels are becoming too high, treatment will be started to help the body break down the bilirubin.

The most common treatment for jaundice is light therapy, also known as phototherapy, and often referred to as bili lights. During phototherapy, the baby is exposed to special lights that often look blue/green/white. These lights may be placed above your baby’s incubator and or in the form of a fiber optic blanket. During the time the baby is under the lights, the eyes will be covered with shades to protect them from any damage the light could potentially cause. The infant will typically be wearing nothing but a diaper, so that as much skin as possible is exposed to the lights. Bilirubin is very sensitive to the light and it will begin to break down and be excreted in the baby’s stool. It is common for an infant to have more frequent and watery bowel movements while undergoing phototherapy.

Once the baby is placed under phototherapy, the levels of bilirubin in the blood are frequently checked, through a blood sample often taken from a heel stick. The levels will plateau and then begin to fall within a few days. If the infant is under several lights, one light at a time will be removed until the levels are low enough for the light therapy to be stopped altogether. The baby will be closely monitored so that the levels do not begin to rise again once the phototherapy is discontinued.

Sources:

American Academy of Pediatrics. Subcommittee on hyperbilirubinemia. Clinical practice guideline: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316

Watchko, J.F. & Maisels, M.J. "Jaundice in Low Birthweight Infants: Pathobiology and Outcome." Archives of Disease in Childhood Nov. 2003; 88, F455-8

Morris et al. Aggressive Versus Conservative Phototherapy for Infants with Extremely Low Birth Weight. New England Journal of Medicine, Oct. 30, 2008

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