Over the years, we all have seen lots of newborn babies diagnosed with jaundice on the 3rd or 4th day of life, which turn out to be of great concern for most parents. The first thing that comes to mind (esp. of grandparents) is that in the old day’s jaundice was not so high, why is it now? are doctors overdiagnosing it? Is our baby kept unnecessarily in the nursery? I will try to answer these questions in this article and will not go into too many technical details.
Facts: Jaundice is a universal phenomenon i.e. it occurs in every baby who is born.
- The normal trend is that Jaundice starts from day 2 or 3 and rises till the 7th day and decreases gradually by the 14th day of life. If it goes beyond a certain level then we need to treat it, otherwise, it will decrease on its own with time.
- Sunlight can not decrease jaundice. Enough scientific data is there, as it requires a particular wavelength of light to be given from close range in order to decrease it. Still, some of the doctors ( who have not updated their knowledge ) might suggest sunlight exposure, which is incorrect. However giving sunlight exposure to your baby has various other advantages most important being Vitamin D3, hence it is advisable to give sunlight but not for jaundice.
Important points for parents:
- Do not panic, it is very normal for babies to have jaundice and it is easily treatable by giving Phototherapy in most cases.
- But if there is a significant delay in starting phototherapy and the bilirubin level rises very high it can cause brain damage that cannot be reversed.
- It cannot be predicted at birth how high jaundice will go i.e.most likely you will be told about jaundice by your child doctor on day 3 or 4 of life (that unfortunately, usually coincide with the timing of your discharge from hospital).
- There is no way that it can be prevented as it is a normal (or physiological) phenomenon.
- As the treatment is so simple and the risk if not treated is so high, it’s always better to be cautious and over-treat rather than under-treat.
- Sunlight does not have any effect on jaundice as the distance is too far away and a particular wavelength of light is required to decrease it.
- Have faith in your doctor, not everyone is there to make money, most child specialists are honest and have a soft corner for children.
Given above is the chart most commonly used by newborn specialists and Pediatrician.
Further details regarding Jaundice (if you wish to know in details, otherwise you can skip it):
- We as a doctor has various cut off values for bilirubin level. ( Bilirubin levels are tested in the blood which helps in assessing the severity of jaundice). These cut off guide us to decide whether your child needs treatment or the level of bilirubin is within normal limits and the baby can be sent home. These cut-off values vary as per, how old is your baby, what was birth weight, how mature your baby was i.e. born as per date or before that, blood group of baby and mother, etc.
- In most of the babies who are born on time and are good size babies and whose blood group matches their mother, jaundice is less likely to go above danger level (however phototherapy may be needed).
- As the baby grows older, his liver starts functioning better and he can tolerate a higher level of jaundice. For eg a bilirubin level of 12 at 36 hours of life is more alarming than a level of 15 at 60 hours of life.
- The best thing which you as a mother can do for your baby is breast feed, as feeding gets better child is able to metabolize and tolerated bilirubin levels better.
- This jaundice in newborn babies (indirect bilirubin is high)technically different from what usually occurs in adults (direct bilirubin is high). And it is not very dangerous unless levels become too high. A very high level of indirect bilirubin can cause brain damage, and once that damage occurs, it’s difficult to treat, and a child`s brain functions are hampered for life.
- As medical science has evolved, we are able to diagnose more cases and start phototherapy early, and actually prevent lots of cases of brain damage, which were there in past. (enough scientific data is there to suggest a decrease in the incidence of bilirubin-induced brain damage).
- Besides today most of us want to have one baby or at the max 2, and do not want to take the risk and want our children in the best health.
- Treatment of Jaundice is Phototherapy and in rare cases of very bilirubin Exchange transfusion.
- Phototherapy: Special wavelength lights are given to babies from a particular distance. If the level is high, we might give light from both sides i.e. one above the child hanging and one below the child. We give it continuously, interrupted only for feeding. We keep monitoring bilirubin levels and do repeat blood tests 12 to 24 hours usually but in some cases more frequently. It usually takes around 48 hours to get jaundice in the lower range but the time taken to control jaundice is very variable.
- Exchange transfusion: In this, we change the whole blood of the baby gradually over few hours and replace it with blood from the blood bank after cross-matching. It’s a relatively serious process and is our last option when bilirubin levels are very high and neurological damage is suspected.
If you really want to go in for further detail then this is the link to know in detail regarding Jaundice.
It’s virtually impossible to write everything here, so for any queries, feel free to contact us or your pediatrician. It’s your right to the discussion, the plan of care of your baby with a treating pediatrician or Newborn specialist.
Regads Dr. Rahul Varma