Category Archives: newborn

Erb’s palsy ( common injury to baby during birth)

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Erbs palsy  ( brachial plexus injury)

One of the common type of birth injury which happens in newborn baby while delivery. (happens mostly in assisted deliveries like vaccum or forceps). In this injury there is damage to nerves supplying shoulder and arm; which in turn leads to decrease in movement of that shoulder. Nerves are 5th and 6th cranial nerve (part of brachial plexus nerves) , which are damaged while passing through a point called Erb’s point.

One way that the brachial plexus nerves are affected is when the baby is passing through the birth canal at an awkward angle, with the head being turned to one direction while the arm is being pulled in the opposite direction.

1-2 babies per 1000 newborn delivery worldwide are affected.

Various risk factors involved in this condition are

  1. Large size baby/ good weight of baby.
  2. Assisted delivery .eg use of forceps or vacuum
  3. Excessive pulling/ traction on shoulders during delivery
  4. Gestational diabetes mellitus
  5. Prolong labour

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Symptoms:

  • Not able to move upper limb well. Especially shoulder joint. Affected arm is hanging by side of body and may be bent at elbow.
  • If not able to move even fingers; (not able to grip , your fingers properly) then it suggests severe injury and involvement of lower plexus of nerves too.
  • Can have collar bone fracture along with it, which might be worsening the movement of that side.
  • It often looks like that baby has paralysis of the affected side

 

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Types of Nerve Injuries

There are four types of nerve injuries.

  1. Neurapraxia: nerve is stretched, not complete tear. (so recovers early within 3 months).
  2. Neuroma: more serious damage to nerves
  3. Rupture: nerve is torn; will need intervention(as it will not heal on its own)
  4. Avulsion: is complete tear and most serious of all. ( luckily it is very rare)

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Treatment:

  • Multidisciplinary approach will decide the plan of care for baby: will include pediatrician, need help from neurologist, orthopedic and neuro physiotherapist.
  • Intermittent immobilization and positioning to prevent contractures
  • Gentle massage (as advised by physio)
  • Surgery if severe damage to nerve or complete tear of nerve.
  • Electric stimulation may help

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Prognosis:

  • It depends on degree of damage: likely most of the cases are mild.
  • If the hand grasp/ grip is good and finger movement is present: it suggests good prognosis.
  • It may take few months to few years to recover.

Be in regular follow and adhere to advice of your doctor.

Regards

Dr Rahul varma

Why breastfeeding is good ?

Why there is so much importance given to breast feed these days and what are its benefits to the baby and what are benefits to mother ? All  parents esp. the first time couples have this query. Few of the important points in this regards are

Benefits to baby:

  • Warmth to baby along with increased bonding between mother and child.
  • Easily digestible ( They say breast milk is “Tailor made as per requirement of your baby” )
  • No preparation is needed, ready to use.
  • Hygiene is maintain, no chance of contamination with micro organisms.
  • Best nutritious value i.e all the ingredient of balanced diet for baby.
  • Increases Immunity of your baby.
  • Prevents against allergies.
  • Prevents various Infections. There is less incidence of ear infections, cough, cold, loose motions and other serious illnesses in breast feed babies.
  • Best for optimum growth and development of your child.

Benefits for you (Mothers):

  • Pre Pregnancy figure achieved earlier and easily in mothers who opt to breast feed their baby. More calories is lost in breast feeding.
  • Natural Contraception. For 1st 6 months if Mother decides to exclusively breast feed child and her periods have not started, then high chance are there for natural contraception.
  • Less incidence of ovarian and breast cancers in breastfeeding mothers.
  • Increased bonding with their child.
  • Less incidence of emotional disturbances

Besides above mentioned advantages, another point I want to make is ” breast feeding is cheapest,  most hygienic and most nutritious food for your child, which will help in better brain development also “

Stay healthy

regards

Dr. Rahul Varma

Breast feeding is the best gift from a mother to his/her child

” Breast feeding is the best gift from a mother to his/her child “

breast feeding is the best option which mother has in regards with fulfilling nutritional needs of their newborn babies and to ensure that baby reaches its growth potential. but sometimes its very challenging and difficult especially in first time mothers .

  • Preparation for the same should start during antenatal classes i.e. before delivery. (providing all pregnant women with information and counseling)
  • Breast feeding should be initiated as soon as possible after delivery. (within 1 hour, if medical condition of both baby and mother is stable)
  • During time spent in hospital it is advisable to keep mother and baby in same room i.e “rooming in”. Skin to skin contact can provide warmth to baby along with ample time for feeding.
  • Assessment and teaching by doctors and nursing staff, regarding correct technique and need for proper attachment for establishing breast feeding.
  • First 48 hours, babies nutritional requirements are less, so milk output is less and babies urine output is also less. Gradually over 1st week of life , babies nutritional needs increases, so correspondingly mothers milk output increases and urine output also is 8 to 10 times per day.
  • Most important thing is to have confidence in yourself that you can breast feed (as every mother breast feeds and you are no different). It takes time to develop arelationship with your baby.
  • Breast milk output increases by help of 2 hormones secreted by brain (oxytocin and prolactin). one of these hormone is secreted when child sucks on breast and other when you have positive thoughts in mind. So if are having relaxed mind free of negative thoughts and your baby is sucking well on your breast, you can rest assure that you will have adequate milk for your baby.
  • Exclusive breast feeding i.e. no other pre lacteal feeds like honey, gripe water should be practiced for 1st 6 months. Remember god has sent the baby, and digestive system is best suited to absorb breast milk and anything extra done on your part can cause more harm then benefit.
  •  If your baby is sucking well on breast, passing urine >8 to 10 times in 24 hours and gaining weight well, you can be assured that your breast milk output is adequate for needs of your baby.
  • Confidence on your part and proper guidance from your pediatrician can ensure that breast feeding is a feeling you will cherish for rest of your life. \

Stay healthy, take nutritious diet and breast feed your baby as ” breast feeding is the best gift from a mother to his/her child “

 

Healthy kids, Happy family

regards

Dr Rahul

Common newborn skin condition

Following are the common newborn skin conditions which might look like very serious but usually do not warrant any immediate treatment.

 

Mongolian Spots

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Birth marks bluish in color, sometimes look like a bruise mostly on buttocks and back. They are harmless and disappear gradually with age, sometimes by school. No medical intervention required. These are very common in dark skinned babies.

 

Pustular Melanosis

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They are small blisters which may be present right after birth. They will gradually disappear with time in few days. They peel open and dry in few days. However opinion of doctor should be taken to rule out other serious illness which can cause similar illness.

 

 

Milia

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Milia are tiny white spots mostly over nose and face. These are caused due to secretions from glands on skin. Disappear by 2 to 3 weeks of age. These are very common in newborn babies.

 

Miliaria

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They are often referred as Prickly heat or Heat rash. Mostly occurs due to hot and humid environment. Mostly occurs in skin folds or covered area where sweating is maximum. They will go away with time. Mainstay of treatment is to keep skin dry and proper air circulation.

Erythema Toxicum

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They are very common type of rashes which are present soon after birth. They are multiple red color rash, can be present all over the body; mainly at tummy and back. No treatment is needed and they will go away with time in a week or so.

 

 

Capillary Hemangiomas

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They are raised red spots which look like strawberry. They occur due to underlying blood vessels.  They might enlarge during first year of life but will eventually fade out by school age. No active intervention is needed at birth.

 

Port Wine Stain

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They are Large, flat, and irregularly shaped dark red or purple areas. They occur on face and neck. They are due to blood vessels under the skin. But they do not disappear and will need treatment.

Caput

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Caput is irregular swelling on scalp leading to irregular shape of head. Mostly occurs during vaginal delivery which subsides with time over next few days. It needs to be differentiated from more serious condition called cephalhematoma.

Epstein Pearls

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These are tiny whitish yellow colored lesions seen on palate. They may look like pus but are benign. They occur in newborn and disappear by 2 to 3 weeks of life. No active intervention is needed.

 

Regards

Dr Rahul Varma

What does father go through once baby is born?

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Being a father is never easy.

No doubt Mothers go through a lot in upbringing of child (and that is incomparable), but father is always caught in a dilemma how to react to this new situation at home.

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They have mixed feelings, they want to help and take care of child but they are also scared regarding how to go about it. Dealing with small baby is never easy. Fathers are anxious (as they might hurt the child).

What need to be done is spend time with newborn and mother. Observe closely and help mother in daily routine of baby care. Which include changing diaper, burping the child, keeping the child in your lap, bathing , clothing etc.

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As you will spend time and start helping, you will grow in confidence and will start enjoying child care.

Trust me, the joy and happiness which a child brings with him is awesome. The smiling face of your child can make you forget all the tension of life.

So relax and enjoy the next phase of your life.

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For any queries feel free to contact your child specialist or meet us at Maya Clinic.

 

Regards

Dr Rahul Varma

“Healthy kids, Happy Family”

New born Babies: What to expect during first year of Life

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With the arrival newborn babies, all eyes are on baby. Your whole world now revolves around him/her.

Once the initial period of anxiety and fatigue is over, real test of characterstarts. Sleepless nights, doing things which you have never done before (cleaning potty, changing diapers, preparing feeds for babies, giving bath to the little one, making baby sleep in your lap etc) can be really demanding as well as pleasurable.

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Parenting Tips:

·         Talk to your baby as much as you can, your smile means a lot to your baby. Sing to your baby, read stories, play light music. React positively to every sound baby makes.

·         Babies want your attention all the time. You keep playing with them and they will be happy but the moment you leave them alone they will start howling.

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·         They are part of you only (baby is made from genes of both the parents); so they have all the emotions which you have. They feel happy, sad, agitated, and anxious, want your love and attention and feel secure in your arms. But they have only one way of expressing their feelings and that is crying (more so in younger kids less than 3 months).

·         So every crying baby is not necessarily hungry or in pain. They might just want your attention and love and the moment you cuddle and hold them they will stop crying.

·         Once the child start moving it is important to keep child in safe environment i.e away from sharp objects and prevent from falling down from bed.

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·         Do not shake the baby; slow rocking movements are better to calm the baby.

·         It is better to make sure your baby sleep with back to bed (especially when unsupervised).

·         Use car seats while travelling; believe me they are much safer (especially with the rapid increase in road traffic accident in India).

·         Avoid warm fluids (water, milk, tea, coffee etc) near child and prevent burn injuries (hot cup of tea is common cause of burn in small children).

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·         After 6 months of age; when you start giving food, make sure it is properly mashed and give in small bites only to prevent choking.

·         Vaccinate your child on schedule. Prevent from infections as much as possible; wash hands regularly.

·         Most important is to take care of your health as a parent. Because you can give your 100% in baby care only when you are physically, mentally and emotionally fine.

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·         Have faith in your abilities and listen to your inner feeling.

 

Feel free to contact your pediatrician and discuss in detail all your queries related to babies (never think your question might be silly).

We at MAYA CLINIC will be more than happy to answer any of your queries.

 

Regards

Dr Rahul Varma

Kangaroo Mother Care: A precious gift for babies who are born too soon

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 What is Kangaroo Mother Care (KMC)?

Kangaroo Mother Care is a way to give warmth to babies who are born too soon by skin to skin contact mother. It has other advantages like better feeding, emotional bonding and better long term neurological outcome. It can be given by father or any other member of family as well.

KMC tips

Preterm babies have very little fat and hence are more prone to cold stress and hypothermia. Skin to skin contact keeps baby warm and help all the other body functions to go on smoothly.

Technically it is defined as procedure in which baby is held on to chest of an adult (mostly mother) with skin to skin contact for long duration of time.

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KMC is given to whom?

  • Best suited to babies who are preterm
  • Full term babies with birth weight less than 2 kg.
  • Babies should not be suffering from other serious health issues (heart rate and breathing is normal).

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How to give KMC? Proper technique

  • Baby is placed on mother’s chest between breast with babies chest facing mother’s.
  • Given day and night.
  • Held in place by cloth that is wrapped and yied at back as depicted in photographs.
  • Kangaroo Mother Care could save an estimated 450 000 preterm newborns a year.

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Benefits of KMC?

  • Warmth
  • Frequent breastfeeding
  • Emotional support
  • Protection from Infection
  • Stimulation
  • Love and bonding

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Kangaroo Mother Care can be given by any family member. It is very precious gift for parents who are not financially well to do. And in very poor parents it could be the only hope of survival.

Kangaroo Father Care

Regards

Dr Rahul Varma

First aid in burn Injury

 

 

In simple words Burn means an injury to the skin from something hot. Most common type of burn injury is SCALD (which is caused due to hot liquids). Burn injury can range from mild to life threatening injury; some can be treated at home, while others may need emergency medical care.

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What to do when burn happens?

  • Take child to safer place: Make sure the Area is Safe and there is no possibility of further injury
  • Remove cloths: if burn injury is over cloths remove them immediately (except if it is badly stuck to the burn).

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First Aid to be given:

  • Running water for 20 minutes: Put the injured area under running water for 20 minutes. Water should be cool not cold. Even if you attend to injury after sometime, still it will be better to use running water (most useful in 1st 3 hours of injury).
  • Cool the burn area (but not the child). Cooling the burn wound will help in better recovery, but if wound is very large , do not cool for long as it may cause hypothermia in young children.
  • It is best to cover burn with lightly applied gauze bandage or with loose, light clean wet cloth. We should also raise the burned area.
  • Do not apply any powder or oil or ointment over burn area; things like butter or atta can make burn injury worse.
  • If you have Ibuprofen; give one dose to your child (if child is awake and alert).
  • Do not break blisters that might have formed.

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When to consult doctor immediately:

  • IF burn involves face, genital area or child is suspected to have airway involved, it is best to consult doctor as soon as possible.
  • IF large area of body is involved in burn injury.
  • If burn is very deep and muscles or bone or tendon can be seen.
  • Whenever in doubt and especially is child is very small
  • Burn injury occurs due to electric shock or chemical injury.
  • Burn looks infected (There is swelling, pus, redness of the skin near the wound).

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Think Prevention!

  • Keep a vigil around , if there is hot water or tea or hot milk around
  • Keep children away from heaters, iron/steam press, burning candles etcBefore giving your child bath check the temperature of water in the tub or bucket.
  • Keep fire extinguisher in high risk areas
  • Do not allow children to play around when something is cooking in kitchen.
  • In winters be careful with kids near bonfire.

Feel free to contact MAYA CLINIC or your child specialist for any other query related to this topic or any other health issue regarding kids.

 

Regards

Dr Rahul Varma

“Healthy Kids, Happy Family”

How to increase breast milk effectively? (For breast feeding mothers)

Breast Milk production increases by two major mechanism, one is when your baby latches on breast well and frequently feeds (prolactin hormone is secreted), and 2nd is when you are relax and stress free (oxytocin hormone is secreted to increase milk output).Mother’s should drink plenty of liquid, it will help them keep well hydrated.

One of the things that worries most new mums is whether they’re producing enough breastmilk. Unlike feeding bottles, breasts do not come with volume markings to measure the quantity of milk consumed.

Often, when a baby seems to demand more feed or the breasts seem less full, a mum concludes that she has low milk supply. But in most cases, this isn’t true. “The amount of breast milk depends on the health of the new mom and her attitude towards breastfeeding,” says Dr Swati Thoda, nutritionist and lactation consultant, Hiranandani Fortis hospital, Navi Mumbai.

A mother’s body produces milk in response to her baby’s suckling. The mum who allows frequent suckling, easily increases the supply of milk with the increase in the hormone, prolactin. During the initial week post birth, the lactating mother may experience pain and discomfort in her nipples as her infant nurses. This shouldn’t deter her from breastfeeding as it may affect the supply.
Breastmilk production works on demand. The more your baby nurses, the more your body produces milk. Do not keep a tab on the clock and unlatch your baby. You may feel you’re breastfeeding the entire day, but it is good for your baby and for your milk supply!
Consuming adequate liquids will keep you hydrated and enable you to produce milk effectively. “A dehydrated mother may fail to produce adequate milk for her newborn,” asserts Dr Thoda. Drinks like sodas, coffee or tea are to be taken in moderation, as large amounts of caffeine can dehydrate the body, thus decreasing breastmilk production.
Assume a comfortable feeding position when nursing your infant. This will prevent tiredness and back pain and allows the new mom to participate in feeding willingly. Moreover, it permits the baby to latch correctly, enabling effective suckling. The use of a feeding pillow might help a mum to achieve a good latch.
Breastmilk formation greatly depends on the will of the mother. If you are stressed, it may hamper your ability to nurse. Take a deep breath, relax and willingly feed your baby.
Eating healthy throughout the day will maximize the energy you have as a new mum and make up for the calorie loss that happens during breastfeeding. Certain foods also aid in boosting milk production naturally.
Galactagogues are herbs or medicines that are used to increase lactation or stimulate milk production in a lactating mother, or in a mother who wants to induce lactation. Herbs such as shatavari, ashwagandha and fenugreek are great galactagogues used in certain tablets and powders available in the market. “These may be used in first 2-3 days post birth but only under the advice of the gynaecologist or a lactation consultant,” informs Dr Thoda.
For mums whose babies are unable to latch or are confined to the NICU, a breast pump may be used to mimic the action of suckling and hence, jumpstart the production of breastmilk. Connect with a veteran mother or a lactation consultant if you need to use a breast pump.
Smoking, drinking alcohol, stress, consumption of birth control pills, fatigue, immediate new pregnancy also may be causes of low breastmilk supply.In addition to the above, hypothyroidism, medicines like antihistamines, decongestants or diuretics, Polycystic Ovarian Disease(PCOD), or an attempt of quick weight loss post delivery could also contribute to lowered milk production.

 

Jaundice in Newborn

Jaundice: why is the incidence of jaundice in newborn baby rising ?

Over the years , we all have seen lots of newborn baby diagnosed with jaundice on 3rd or 4thday of life, which turn out to be of great concern for most parents. First thing that comes to mind (esp. of grand parents ) that in old days jaundice was not so high, why is it now ? are doctors over diagnosing it ? is our baby kept unnecessarily in nursery?

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I will try to answer these question in this article and will not go into too much technical details.

Facts: Jaundice is universal phenomenon i.e. it occurs in every baby who is born.

  • Normal trend is that Jaundice starts from day 2 or 3 and rises till 7th day and decreasesgradually by 14th day of life. If its goes beyond a certain level then we need to treat , otherwise it will decrease on its own with time.
  • Sunlight can not decrease jaundice. Enough scientific data is there, as it requires particular wavelength of light to be given from close range in order to decrease it. Still some of the doctors (  who have not updated their knowledge ) might suggest sunlight exposure, which is incorrect. However giving sunlight exposure to your baby has various other advantage most important being Vitamin D3, hence it is advisable to give sunlight but not for jaundice.

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Important points for parents:

  • Do not panic , it is very normal for babies to have jaundice  and it is easily treatable by giving Photo therapy in most cases.
  • But if there is significant delay in starting photo therapy and bilirubin level rises very high it can cause brain damage which cannot be reversed.
  • It cannot be predicted at birth how high jaundice will go i.e.most likely  you will be told about jaundice by your child doctor on day 3 or 4 of life (that unfortunately ,usually coincide with the timing of your discharge from hospital) .
  • There is no way that it can be prevented as it is a normal (or physiological) phenomenon.
  • As the treatment is so simple and risk if not treated is so high, its always better to be cautious and over treat rather then under treat.
  • Sunlight do not have any effect on jaundice as the distance is too far away and particular wavelength of light is required to decrease it.
  • Have faith in your doctor , not everyone is there to make money, most of the child specialist are honest and have soft corner for children.

Phototherapy charts

Given above  is the chart most commonly used by newborn specialist  and Pediatrician.

 

Further details  regarding Jaundice (if you wish to know in details,  otherwise you can skip it):

  • We as a doctor  has various cut off values for bilirubin level . ( Bilirubin levels is tested in blood which helps in assessing the severity of jaundice). These cut off guide us to decide whether your child need treatment or the level of bilirubin is with in normal limits and baby can be sent home. These cut off values varies as per , how old is your baby, what was birth weight, how mature your baby was i.e. born as per date or before that, blood group of baby and mother etc.
  • In most of the babies who are born on time and are good size babies and whose blood group matches their mother, jaundice is less likely to go above danger level (however photo therapy may be needed).
  • As the baby grows older, his liver starts functioning better and he can tolerate higher  level of jaundice. For eg a bilirubin level of 12 at 36 hours of life is more alarming than level of 15 at 60 hours of life.
  • Best thing which you as mother can do for your baby is breast feed, as feeding gets better child is able to metabolize and tolerated  bilirubin levels better.
  • This jaundice is newborn babies (indirect bilirubin is high)technically different from what usually occurs in adults (direct bilirubin is high). And it is not very dangerous unless until levels become too high.  A very high level of indirect bilirubin can cause brain damage, and once that damage occurs , its difficult to treat and child`s brain functions are hampered for life.
  • As medical science has evolved , we are able to diagnose more cases and start photo therapy early and actually prevent lots of cases of brain damage, which were there is past. (enough scientific data is there to suggest decrease in incidence of bilirubin induced brain damage).
  • Besides today most of us wants to have one baby or at the max 2, and do not want to take risk and want our children in best health.
  • Treatment of Jaundice is Photo therapy and in rare cases of very bilirubin Exchange transfusion.
  • Photo therapy:Special wavelength lights are given to babies from a particular distance. If level is high , we might give light from both side i.e.  one above the child hanging and one below the child. We give it continuously, interrupted only for feeding. We keep monitoring bilirubin levels and do repeat blood tests 12 to 24 hours usually but in some cases more frequently. It usually take around 48 hours to get jaundice in lower range but time taken to control jaundice is very variable.
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  • Exchange transfusion: In this we change the whole blood of baby gradually over few hours and replace it with blood from blood bank after cross matching. Its relatively serious process and is our last option when bilirubin levels are very high and neurological damage is suspected.

If you really want to go in for further detail then this is the link to know in detail regarding Jaundice.

Its virtually impossible to write everything here, so for any queries , feel free to contact us or your pediatrician. Its your right to discussion , the plan of care of your baby with treating pediatrician or Newborn specialist.

Stay healthy

Regards

Dr Rahul Varma

“ Healthy kids, happy family”