When red blood cells break down they produce iron and bilirubin. The iron is reabsorbed by the liver and stored for later use. At birth the immature liver can not always process the excess bilirubin. It is therefore released into the blood and tissues and may cause a yellowing of the tissues. An extreme buildup can lead to brain damage.
Types of Jaundice:
-Physiological
Typical age of onset is 3-5 days. Disappears within 7-10 days
May be related to underfeeding
This kind of jaundice will correct with frequent feeding and is not concerning
Occurs in 50% of full term infants and 80% of premature infants
-Pathological
Typical age of onset is 1-2 days.
Three categories of pathological jaundice
-Increased breakdown of red blood cells (hemolytic anemia)
-Problems with the liver’s ability to process bilirubin (enzyme deficiency, infection, metabolic
disorders)
-Increased reabsorption of bilirubin in bowels (gastrointestinal obstruction)
-Late onset
Onset begins AFTER the 3rd day and peaks between day 5 and 15
Related to breastfeeding, may require a break from breastfeeding
Persists for weeks to months
Risk Factors for Developing Jaundice
-Prematurity -Family history of jaundice
-Pitocin use in labor -East-Asian and Mediterranean descent
-Birth trauma, including bruising -Feeding difficulties
-Born to a mother with a different blood type or RH factor
-Infrequent passage of tools can cause bilirubin to be reabsorbed by the intestines
Prevention
-Avoid drugs in labor particularly pitocin, glucose/dextrose, sedatives and neonatal vitamin K
-Delay cord clamping to allow full placental transfusion
-Encourage passage of meconium shortly after birth
-Nurse frequently
-Mother can consume plenty of citrus, catnip tea, dandelion and natural iron supplements
Treatment
-Frequent passage of stools should be encouraged by frequent nursing
-Homeopathic chelidonium (12c)
-Phototherapy with “bili lights” at the hospital or home or exposure to sunlight
-In severe jaundice, treatment is an exchange transfusion (>30mg/dl)
Bilirubin Levels Normal Full Term Normal Premature High Risk
1st 24 hours 2-6mg/dl 1-6mg/dl 6-8+
Day 2 6-7mg/dl 6-8mg/dl 11.8-13+
Day3-5 4-12mg/dl 10-15mg/dl 13-17.7+
Danger Signs in Jaundiced Infants
-Lethargy -Poor feeding -Vomiting
-Inadequate excretion of urine or stool -Dark urine or light stools
-Onset within the 1st 24 hours or extreme jaundice at any time
-Signs of neurotoxicity such as unusual or high pitched cry