oh! the yellowness in New borns!

The first response of new parents to their baby having Jaundice is 'What?!', there is fear, concern and worry and naturally so! Sometimes second time moms take an additional effort to feed the baby frequently and ensure the baby's intake in on track but still the baby may get jaundiced.

'How? I did all that i am suppose to' would be her response. Well, this article looks to answer and inform the startled 'How?' of the mums 

 What is Jaundice and why it happens?

In each one of us, there is regular destruction of RBC's. The hemoglobin in the RBC gets converted to Bilirubin. Bilirubin attaches itself to a protein called Albumin which takes the Bilirubin to the liver, almost like a bus that Bilirubin takes to reach its destination. The liver undertakes a process called conjugation to convert the bilirubin to make it water soluble and be excreted through urine or stools

What happens at birth?

When a fetus, the process of conjugation is taken care by the mother's liver. When the baby is born, he/she is now responsible for the conjugation and they liver has to gear up for this process. The baby may not be very efficient with an immature liver and an overload of Bilirubin in the blood stream. This Bilirubin gets accumulated in the skin causing the yellowness or Jaundice.

As days pass the baby's liver gets more and more efficient in conjugating the bilirubin but we need to monitor the levels of jaundice. Though Jaundice as such is not harmful, it exceeding the safe limits can get harmful as it can enter the Brain and cause irreversible damage. Thus, Pediatricians will closely monitor babes for Jaundice in the first 24-48 hours 

Some causes of Jaundice include:

Physiological changes of heart at birth

In a fetus, the heart usually has normal holes which cases the oxygenated blood and deoxygenated blood to mix. Due to this, a fetus usually has lesser oxygenated blood necessitating more red blood cells to be present so that all the tissues of the fetus get adequate oxygen. 

During the birth process, the holes close, increasing the amount of oxygenated blood in the baby. Thus the baby has lesser requirement of Red blood cells. The extra Red blood cells now die causing a natural load on the liver for conjugation 

Different Blood Type of the mother and baby

This is particularly the case when the mother is RH negative and baby is RH positive. During the birthing process some amount of maternal blood will pass through to the baby. if the mother is RH mother, meaning she does not have RH protein in her blood, her WBC will make antibodies to attack the baby's Red blood cells. These antibodies will cause the baby's Red Blood cells to die, thus creating more destruction of Red blood cells in the babies body and hence more overload of conjugation for the baby's liver. This overload increases the occurrence of Jaundice for the baby.

This can also happen when the blood type has either A protein or B protein.

Breastfeeding in Initial Days

Breastfeeding, though a natural phenomenon, it needs practice from the mothers side and the babies side. Mature milk would start coming in only from day three for the mother, until then the mother and baby work towards establishing a good latch and establishing supply. Colostrum is the first food for the baby, though extremely nutritious the quantity of colostrum is very less, making the intake lesser and thus not really enabling a good stool and urine count.

What best can be done here is to educate to be mothers about the importance of breastfeeding and establishing a good latch, frequent feeding from the first hour of birth. In addition to information being passed on to the new mother, she also needs to be given good verbal encourage, positive and conducive environment for breastfeeding, good rest and nutritious intake of food 

How is Jaundice treated?

• Photo Therapy

When the levels of Bilirubin in blood crosses a certain threshold, your pediatrician will immediately ask for a Photo Therapy to be done. Usually, 12-13 would be the threshold.

In this case, the baby will be kept with only diapers under Bili lights (Blue lights) with her eyes covered. regular blood tests wll be done at 6-8 hours interval or as per the physicians request to monitor the effectiveness of the treatment. The baby will be asked to be taken away from the lights only for feeding and diaper change.

Effects of Photo Therapy

- Frequent passing of stools 

- Passing greenish stools

- Rashes: Rashes in new born is in general a common occurrence. However, Photo therapy could cause rashes too

How does it work? 

The excess Bilirubin in the blood which is yet to get conjugated gets deposited in the skin and hence the yellowness. Under the Bili lights, this excess Bilirubin is made water soluble so it can be excreted. Thus the lights help to ease out the load on the liver causing more excretion

• Exchange Transfusion

An exchange transfusion involves removing aliquots of patient blood and replacing with donor blood in order to. remove abnormal blood components and circulating toxins whilst maintaining adequate circulating blood volume.

What happens when Jaundice crosses into the Brain?

Kernicterus

It is a very rare condition where the excess bilirubin of untreated Jaundice has crossed the thin layer of tissue that separates  the brain and blood. It could possibly cause irreversible damage to the Brain and Central Nervous system

Brain damage caused by high levels of Bilirubin is called Bilirubin Encephalophy

The initial Symptoms of kernicterus in babies are:

 -Poor feeding

-Irritability

- A high pitched cry

- Lethargy

- Brief pauses in breathing

- Their muscles become floppy

Additionally, it could also cause fits (seizures) and muscle spasms casing arching of back and neck 

Treatment usually is an exchange transfusion

In case, the bilirubin causes any serious damage to the brain before treatment, it could cause:

- Cerebral Palsy

- Hearing Loss

- Learning disabilities

- Involuntary twitching in different places

- Problems maintaining normal eye movements

- Poor development of teeth

Good News! This is rare, but caution is required! This occurrence is however very rare. Every new born is very closely monitored for Jaundice and the babies are given Photo therapy as soon as they cross the basic threshold. Therefore, Kernicretus is rare, however it mirrors the need to be concerned about Jaundice and take adequate treatment at the right time

Next Up!

In the next post, we will look into what we can do towards enabling a decrease in jaundice levels in babies. We will also ponder over how Jaundice was treated in olden days, days before the emergence of modern medical science