What is Jaundice or hyperbilirubinemia? It is a common occurrence in newborns, estimates are between 50-60% of full-term babies and 80% of pre-term babies will have jaundice. When babies are inside the uterus they need extra red blood cells to meet their oxygen needs. After birth, these extra red blood cells have shorter life spans and when they break down, they release a substance called bilirubin. The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so that it can be passed out of the body in POOP!
But if there's too much bilirubin or due to the immaturity of the newborns liver, it cannot get rid of it fast enough, the excess bilirubin causes jaundice. Newborn jaundice causes a yellow coloring of the skin and the whites of the baby's eyes. Jaundice typically begins in the eyes and works its way down from there. Jaundice usually peaks in the first two to five days of life, and lasts about one to two weeks. In babies who are breastfed, it can last longer; we don't know exactly why this happens, but it isn't anything to worry about. Jaundice may actually protect babies, because bilirubin is an antioxidant that may help fight infection in newborn infants. This is another reason why parents shouldn't be too worried by a bit of yellowness: not only is it temporary, but it may also be helping their baby as he or she leaves the security of the womb. It can take several days or weeks (even longer in preterm babies) before a newborn’s liver functions fully. In the meantime, it can be hard for babies to get rid of the bilirubin that collects after birth. Low levels of bilirubin are safe, but prolonged high levels may cause brain damage if left untreated.
There are two types of jaundice:
Physiological jaundice- usually appears between day's 2-5 and can last for about 10–14 days. Some breastfed babies can have jaundice for as long as 12 weeks, but it's important that the baby is monitored by your health care provider if jaundice persists so other more serious causes of jaundice can be ruled out.
Pathological jaundice- Is the most serious type of jaundice and requires prompt medical attention. It occurs within the first 24 hours after birth, and is indicative of blood incompatibility, disease or congenital defect.
How do you treat Jaundice?
Most cases of jaundice go away on their own. Others cases depending on the cause, may need specialized Phototherapy
to lower bilirubin levels. If you live in a place that gets excellent sunshine you can expose baby to the natural sunlight for 10 minutes a few times a day, making sure to cover baby's eyes.
The best treatment for physiologic jaundice is frequent and effective breastfeeding—feeding baby at least 8-12 or more times in each 24-hour period.
Watch for your baby’s early feeding cues; don’t wait for your baby to cry, this is a late sign of hunger and can make breast feeding more difficult. The more baby feeds, the more baby POOPS, which will help them to get rid of the excess bilirubin.
Jaundice can also make your baby more sleepy, so it is important to feed baby often even if you have to wake them up to feed. If baby isn’t getting enough milk or is breast feeding ineffectively, or has lip/tongue tie this baby needs extra help or supplemental feeds. If you have questions about effective feeding, or problems feeding contact your provider or a lactation specialist to schedule an assessment.
How do you know baby is getting enough?
Pees and Poops! You'll know your baby is getting enough to eat if they are filling those diapers up. Baby should be having 2-4 wet diapers on days 2-3 after birth, and by day's 4-5 baby should be having 4-6 wet diapers or more. You should see three or more stools a day by day 3. Your baby’s stool will be black (meconium) on days 1 and 2; green (transitional) on days 3 and 4; and yellow (normal) by day 5. This process can be even faster depending on when your breast milk comes in.
Things to watch for!
If you continue to see black stools on day 3 or green stools on day 5, and baby is jaundiced, you should contact your baby’s health care provider. This could be a sign that your baby isn’t getting enough to eat or isn’t transferring milk well during feeds.
Pale-colored poop, or dark urine. Poops should never be pale, and pee should be colorless or yellow not dark brown.
Signs of dehydration: dry or cracked lips, lethargic behavior or excessive sleepiness (a floppy baby), or no wet or poopy diapers.
A high-pitched cry that is shrill.
Jaundice on baby’s hands or feet. This could mean baby’s bilirubin levels are very high and they should be assessed by their health care provider.
If baby refuses to feed, or can’t feed well. The first sign of newborn well-being is a baby that wants to feed and feed often. If your baby suddenly stops feeding contact your provider.
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