ASK THE DOCTOR: No reason to fear jaundice
By DR. JIM MITTERANDOQ My 4-day-old baby has jaundice. Is it dangerous? I am breastfeeding. I have heard breastfeeding makes jaundice worse. Should I switch to bottlefeeding?
A More than half of all normal, healthy infants develop jaundice - a yellowish tinge to their skin or eyes - in the first few days of life. In newborns, jaundice isn't a disease. In most cases it occurs because your baby's liver isn't mature enough to metabolize a normal, breakdown product of red blood cells called bilirubin.
Jaundice used to cause concern years ago because an elevated bilirubin level in the blood could result in brain damage called kernicterus. These days, this is an extremely rare concern because pregnant women are screened for blood type problems. For example, women with Rh negative blood type are given a shot during pregnancy to prevent developing harmful antibodies against the fetus' blood cells.
Nonetheless, jaundice still evokes parental fears. In full-term, newborn infants, jaundice is rarely a concern. Jaundice may require more aggressive treatment if it develops during the first 24 hours of life or if the infant is premature or ill since these infants are more prone to the harmful effects of bilirubin.
If your baby's skin is bright yellow or the jaundice extends below the belly button, follow up with your doctor. Do not be alarmed if the whites of the eyes become yellow since they often change color with mild jaundice. If your doctor is concerned about an elevated bilirubin, he or she will order a blood test to measure it. No treatment is necessary if the bilirubin test measures less than 20. If treatment is required, the infant is either placed under blue lights or is wrapped in a fiber-optic blanket that emits light. Light helps breakdown the bilirubin in the blood. Mild jaundice can be improved by placing the baby in the window dressed only in a diaper during sunlight hours.
A kinder, gentler approach to treating jaundice has emerged over the past 20 years with studies showing that kernicterus is very rare in full-term, healthy newborns. As a result, fewer children now receive light therapy.
Follow up with your doctor if the jaundice does not improve over two to three weeks or if your child feeds poorly or appears lethargic or ill.
Breastfeeding sometimes contributes to jaundice. In the past, this was often treated by changing to formula. These days, mild jaundice can be simply treated by increasing the frequency of breastfeeding or sometimes by supplementing with formula. Frequent feeding helps to increase bowel movements and helps to eliminate bilirubin. Rarely does a child need to be switched to formula. Do not give water or sugar water as this can make jaundice worse.
One final note: Jaundice that develops after three weeks of life, or jaundice in older children or adults, is not normal and requires urgent medical care and evaluation.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, July 15, 2003