Neonatal jaundice, or in lay term, a yellow discoloration of the skin in newborns are a very common condition. In fact, almost every week, I will be treat, either directly or indirectly at least 20 babies a week. That's how common!
Most of these babies are jaundice because of one common problem, that is dehydration. This happen especially during the first few days of life, where the child's demand for milk is inadequately supply by his or her mother. This happen more frequently in breast fed babies. Many mothers want to breast feed their baby, and this is a good thing. However, many force themselves so much, that they just refuse to use supplemental feeds, that is, formula milk. Since it's normal for mothers to have less milk within the first 3 days after pregnancy, then the baby will be dehydrated. So, for these children, the treatment is essentially, rehydrate them! Very simple.
When any mothers see that their babies are jaundice, they need to bring them to seek medical help and have the babies blood checked. There are certain levels of 'jaundice' in the blood, where if it reaches a certain level, will damage the brain. This is called 'kernicterus' in medical term. Nowadays, this clinical condition is rare. Kernicterus is permanent. And the child will have delay in physical development. Though rare, we should not take neonatal jaundice for granted.
If any baby, are admitted to the hospital for jaundice, most of the time we will treat them with a special blue light, just like the one shown here. This blue lights has special frequency and wavelength to reduce the 'jaundice' in the blood and this will help to bring the jaundice level down.
There are other causes of jaundice. Some are due to infection, which need prompt treatment. So, if your babies are jaundice, then don't hesitate to bring them to see a doctor.
Most commonly, in our culture, mothers that just delivered, starts to take some 'traditional medications' during confinement. Some of these 'medications' have a certain biochemical substance, that can cause jaundice to happen. So, it will always be our advice to stop any 'traditional' stuff during that few critical weeks of confinement. I'm not saying that all traditional medications causes jaundice, some of them do, the problem is, no one on earth know which one! So, as always, prevention is better then cure, just stop and wait till at least the child is 2-4 weeks old. By then, even if the child got high jaundice, it won't cause any brain damage!
Hi Dr Paul,
ReplyDeleteThanks for having this blog which as a mother of 2 babies it will be very useful.
As we all know Jaundice is very common, some babies do not have to admit to get phototherapy and some unfortunately.
When bring my 1st born son to paed clinic for 1st check up and review, he was down with jaundice where the level is 190+, the paed ask us to come back again in 1 or 2 days to check the level again. And the 2nd blood test showing that the level is 250+ where the paed advise us to admit my baby to do the phototherapy.
Now with 2nd baby, I bring him see another paed + neonatalogist. Again this time my 2nd baby are down with jaundice and the level is 220+,
But this time paed said my baby jaundice level is not very high and do not need to get the phototherapy. He never ask me to bring back my baby to do the bloodtest after 2 days. Just ask me keep on breastfeed him and if still got jaundice after baby 2 weeks old then only bring back to see him.
Now my baby already 2-3weeks old, he still got jaundice. However I can see the yellowish is not as bad as before. (my 1st born still have jaundice even after the phototherapy and till when he is fullmoon. Another paed + lactation consultant said that it's normal for breastfeed baby to have prolong jaundice)
I wonder how come 2 paed taking different approach on this? which I'm confuse when should ring the bell? when shouldnt?
Hi Addicted2Cook
ReplyDeleteFirstly some how, I don't know why, your comment is not seen on my 'comment'. however i got an email saying you put up the comment. Anyway, I took the liberty to copy and paste your comment here so others can benefit as well. So here is what I got to say.
I think both your paediatrician are confused as well! Ha! Anyway, I'm not going to say who is right or wrong. As paediatrician, we decide to admit a jaundice baby when the child's jaundice level (TSB) has reached a certain level in our 'jaundice chart' that required phototherapy. Now, every hospital has got their own 'jaundice chart'. So if your baby's TSB is 220, for hospital A, may admit for treatment but for hospital B may not! And this is the cause of confusion among all the parents, including myself. The malaysian paediatric association has come out with a guideline as to when to admit jaundice babies for treatment, but unfortunately, not all hospital, be it private or govt, follows them. So this is sad.
We decide if the child needs phototherapy by looking at the TSB level, Weight of the baby, age of the baby and if there's any risk factors (like, Mum's blood Group of O, G6PD deficiency, sick babies, etc). Those with risk factors, the level of which we will treat is lower than those that don't have any of those risk factors.
We usually advice parents to monitor their baby's TSB level at least once in 2 days till the child is not jaundice, to make sure that the level is not increasing trend to a level that needs intensive care!
These are the warning signs if your baby got jaundice.
1) unwell, not active
2) refuses feeds
3) lethargic
4) persistently vomiting (not regurgitating)
5) fever
6) pale
7) reduce urine output (mother of a newborn should change nappy at least 8-10 times per day! anything less than that may not be good!)
8) the stool is pale (meaning almost white in colour)
9) fit/ seizure
10) weight is not increasing
Any of those 10 occur, must go to the hospital to be checked by a doctor.
As I mentioned earlier, most of the time, the cause of jaundice is inadequate feeding or dehydration. This is probably the reason why your paediatrician asked you to feed the child more!
Now that you mentioned that your child is still jaundice after 2 weeks of life, you need to bring your child to the doctor. This is called prolonged jaundice and need to be investigated. There are some diseases, like Thyroid problems (hypothyroid), urine infection, and hepatitis can cause prolong jaundice. So your baby need to be checked out!
Your paediatrician is not right to say that it is normal for breast feed babies have prolonged jaundice. Having a jaundice that is prolonged is abnormal in the first place! Only after we investigate and rule out if there is any other cause for the jaundice, then only we say the prolonged jaundice is due to breast milk, not due to breast feeding.
Breast milk jaundice and breast feeding jaundice is 2 different entity.
I hope I didnt confuse you further. Right now, bring your jaundiced baby to see a doctor.
Hope you can subscribe this blog via email or follow if you like.
Cheers!
Dear Dr Paul,
ReplyDeleteI bring my baby back to see paed today. He took some blood sample to check the liver etc..
also did some urine test to check for infection. Since my baby is fully on breastmilk. He said that if the both test come out ok which means my baby could be having breastmilk jaundice.
Result will be out tomorrow. Will updated you. thanks for your advise!
hi, good to know. Hopefully your baby will be well!
ReplyDeleteHappy new year! Do 'follow' the blog via email if you like!
Dear Dr Paul,
ReplyDeletejust got the phone call from the clinic and the
blood test result is good. Tomorrow will know the urine result. The paed said is breastmilk jaundice.
Dr Paul,
ReplyDeletemy son bilirulin level now is 240++,
then pead said is still ok no need to admit as the level is not up too 300.
I still can breastfeed. But then I'm very worry..
could it due to the red dates water that i'm drinking? aih..
Unfortunately, the only answer i can give you for that question is 'I don't know'.. in fact.. nobody knows! No one knows what are exactly in the dates and no one knows if any of those things in the dates causes problems.
ReplyDelete240 is still high. For those babies that are already more than 2 weeks old, there's no need for any treatment. The bilirubin won't cause any brain damage. It's is good to know that the results are good.
Just wait for the urine result. If it's normal, then you will have no worries.
Yes, i agree with your paeds that it's breast milk jaundice when all the results are normal.
Dr Paul,
ReplyDeletelooks like the level is increasing,
day 5 is 220++
day 20 is 240++
i think tomorrow i'm going to ask the paed
should check the level again after 2 days to see
it's increasing or not.
Do you think it will increase?
if really going to increase, will want to get him to advise whether should be admit my baby
for phototherapy to bring down the level to 100+
It's difficult to say. If your baby is well, and his weight is increasing, then the level should not continue to rise. If it goes up, then your paeds should look out hard the reason for that. If it's just breast milk jaundice, it shouldn't continue to go up.
ReplyDeleteAt the age of 20 days, it doesnt matter if the level is 100 or 300. Still don't need phototherapy. Even if we give phototherapy to bring the level down drastically, that won't mean that it won't go up again.
Dr Paul,
ReplyDeletethe urine result is good too. The paed told me
not to worries and continuing breastfeed the jaundice will slowly goes off.
I told him that i'm still worry ask the level is high. He said it's high if the baby is less than 2 weeks old but my baby is going to be 3 weeks old so i shouldnt worry.
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ReplyDelete