Many normal babies develop a slight yellow discolouration of the skin, known as, particularly on the face, between the third and fifth days of life. This is caused by a pigment in the blood known as which is formed from the normal breakdown of red blood cells. Normally the liver clears from the blood, but, in some babies, particularly if they are premature, it takes a little while for the liver to do this job properly. Usually the jaundice is so mild that it may go unnoticed and it does not affect the baby’s health in any way. This type of jaundice is called physiological because it is a feature of normal babies. Occasionally the jaundice becomes quite pronounced and the more intense it is, the longer it usually takes to fade completely. In this instance, instead of disappearing by the fifth day, it can last into the second week.
Often it is not clear why jaundice becomes so exaggerated, but it does seem to occur in babies who are bruised at birth, those who do not take very much fluid in the first few days and those who are born after an induced labour. Sometimes we have to do blood tests so that we can keep an eye on the precise level of bilirubin in baby’s blood. It is unusual for jaundice to develop during the first day of life. When this does occur it is usually a sign that the baby’s red blood cells are being broken down very rapidly, perhaps because, as in the Rhesus disease, the mother’s and baby’s blood are not compatible. Some breastfed babies develop quite an intense degree of jaundice during the first week of life and this may persist for several weeks before fading spontaneously. In nearly all cases breastfeeding can be safely continued but, occasionally, if the blood tests show a very high level of bilirubin, mothers are advised to stop breastfeeding temporarily until the jaundice starts to fade.
Physiological jaundice requires no treatment and many mothers are proud of their baby’s tan. jaundice is not, however, desirable. If the blood bilirubin level becomes too high and if your baby becomes deeply jaundiced, you will probably be advised to offer him extra fluids, perhaps in the form of sugar water. The difficulty here is that jaundiced babies are sometimes rather sleepy and you may feel frustrated having to work so hard to get him interested in the extra fluids. There is no reason to stir up trouble between you for a few extra ounces of fluid. lt is best to compromise with the baby and, for the time being, to offer feeds at two or three-hourly intervals instead of on demand and be prepared to spend a little longer at each feed.
Phototherapy- ‘light treatment’ is generally reserved for babies with deep jaundice. ln some maternity hospitals, however, it is used quite freely even for milder degrees of jaundice. For this treatment, the baby is unclothed down to the nappy and hisis positioned under a bright source of light which shines on to his skin. The light breaks down the bilirubin that is circulating in the tiny blood vessels in the skin. lt is not ultraviolet light, of course, so there is no fear of the baby getting sunburnt. A soft shield is placed over the baby’s eyes. Several days’ treatment may be needed, punctuated, perhaps, by breaks of several hours each day.
The amount of exposure that a baby requires depends on the blood level of bilirubin. This is checked daily and it can be frustrating if the treatment involves you being separated from your baby for prolonged periods. Normallyis given in the ward nursery but, as the apparatus is mobile, you could ask the staff if your baby can be kept by your bed during treatment. If so, your room will need to be warm and draught-free as the baby has to be unclothed for the treatment. If you cannot have your baby by your side, spend as much time with him as possible in the nursery.
Remember that although the eye shields prevent him from seeing you, he will respond to your voice and enjoy your touch. Treatment will, of course, be stopped temporarily during feeds so take this opportunity to spend a little extra time cuddling your baby. Ensure, too, that the eye shields are removed so that he can see you. Phototherapy causes most babies to lose a little extra fluid in the stools and, as a result, you may notice that these become quite loose. The baby’s skin may also become a little blotchy under the lights, but this is harmless and will disappear once the treatment is stopped.
Sometimes the bilirubin level rises rapidly in spite of, especially when there is a definite cause for the jaundice such as Rhesus incompatibility. In these cases it may be necessary for the baby to have his blood changed by an ‘exchange transfusion`. This is a simple procedure that involves using a syringe to remove a small amount of blood and immediately replacing it with fresh blood from a healthy donor. This is repeated many times over the course of an hour or so and, as a result, the bilirubin is washed out of the baby’s blood stream. It is quite common for babies who are severely jaundiced from Rhesus disease to require several exchange transfusions. If so, do not worry. The technique has been in practice for many years now and paediatricians are very skilled at exchange transfusions.