The diagnosis of jaundice in their newborn baby is often very frightening to new parents. They immediately begin to think something is very wrong with their infant, and may not be fully informed about the facts, which are actually very reassuring.
It is very common
How jaundice occurs
Bilirubin is measured in milligrams per deciliter of blood, or mg/dl. The average level for an adult is 1mg/dl. The average full-term newborn will have a peak level of 6mg/dl on the third or fourth day of life. Levels usually go down to about 2 to 3mg/dl by the end of the first week, gradually reaching the adult value of 1mg/dl by the end of the second week. It usually takes the newborn's liver a week or two to mature enough to handle the build-up of bilirubin in the blood. It is important to know that there is no evidence that bilirubin levels of less than 20mg/dl during the first week of life, and less than 25mg/sl after that have any harmful effects of healthy, full-term babies.
So, if jaundice is such a normal condition, why all the concern? Because there are rare medical conditions which cause bilirubin to rise to dangerous levels, and can cause brain damage. Years ago, before we had the diagnostic tools and treatment options that we have today, some babies with very high bilirubin levels suffered from a condition called bilirubin encephalopathy, or kernicterus. This is rarely seen today, and then usually only in very premature or sick babies. Doctors today monitor bilirubin levels very carefully, and initiate treatment well before levels get high enough to cause problems. There are three types of jaundice: Normal, or physiologic jaundice, affecting the majority of newborns; pathologic jaundice, caused by medical conditions such as blood type incompatibilities (the most common cause), as well as prematurity, infection, liver damage from rubella, syphllis or toxoplasmosis, and metabolic problems such as hypothyroidism; and late-onset, or breastmilk jaundice (probably caused by a factor in some mothers' milk that seems to delay or prolong the excretion of excess bilirubin).
It is important to understand the different types of jaundice, because each has different causes, consequences and treatments.
Types of jaundice
In the baby with physiologic jaundice, bilirubin levels will usually peak between the third and fifth days of life and are usually less than 12mg/dl. Occasionally they will go higher than 15mg/dl. Most doctors will monitor levels closely during this time, checking the baby's levels with a blood test, pricking his heel, toe or finger. If the levels are rapidly rising, or are 20mg/dl or higher (lower levels are used with premature infants), phototherapy is often suggested. This is a treatment which involves exposing skin to blue range light which breaks down the bilirubin and makes it more easily excreted.
Years ago, nurses found that babies who were in beds near sunny windows had lower bilirubin levels. Researchers then found that phototherapy can make bilirubin levels drop quickly. Until the past few years, babies with high bilirubin levels had to be in the hospital for phototherapy treatments. Now, with new technology, babies can receive phototherapy at home using bili-blankets, provided by home health care providers. In most cases, bilirubin levels drop rapidly after phototherapy is initiated, and once the levels begin to go down, they almost always continue to decline. Usually only a day or two or therapy is needed. Most cases of physiologic jaundice will resolve without the use of phototherapy.