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 4th day 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?
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 decreases gradually 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.
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.
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.
- 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.
Dr Rahul Varma
“ Healthy kids, happy family”