Jaundice In The Newborn Baby by anamaulida


									Jaundice is a symptom, not a disease and there are many reasons for it
happening. It is recognized primarily by the yellow discoloration of the
skin.In the womb, baby does not breathe but rely on a high level of red
blood cells to receive enough oxygen from the mother. After birth, the
extra red cells are broken down. One of the waste products is a substance
called bilirubin which is fat soluble (unconjugated bilirubin) that is,
it dissolves in fat. This bilirubin must be taken to the liver to be
changed into water soluble bilirubin (conjugated bilirubin) which is then
passed out through the urine, stools and sweat.If for some reason the fat
soluble bilirubin is not converted, it will attach itself to fatty
tissues that it comes into contact with, mainly in the skin and brain. If
too much bilirubin attaches itself to fatty tissues in the brain it may
cause brain damage.Physiological jaundice is due to the above process and
is the most common. It usually appears on the 3rd day and disappears by
7th day. It is not dangerous as long as the bilirubin level does not go
up too high.Early feeding after birth may reduce the prevalence of
jaundice therefore try putting baby to the breast in the delivery room.
This also stimulates the breast to start producing milk.Other main causes
of jaundiceExcessive bruising from a traumatic birth causes more than the
usual amount of red blood cells to be broken down, leading to higher
levels of bilirubin to be conjugated.The preterm baby is more likely to
become jaundiced because of an immature liver which cannot cope with the
high load of bilirubin.G6PD deficiency is a condition where an enzyme
necessary for the conjugation of bilirubin is missing or
insufficient.Breast milk may interfere with the liver's ability to
conjugate bilirubin therefore the jaundice may be prolonged. Often, it is
not necessary to stop breast feeding but if the levels become too high,
the paediatrician may recommend stopping for a couple of days for the
levels to come down.Blood group and Rhesus incompatibility causes
jaundice to appear during the first 24 hours of life. It is important
that all pregnant women go for prenatal checkups in order to identify the
possibility of this problem occurring, so that preventive treatment for
jaundice can be started fairly quickly after birth.Prenatal infection of
the mother such as rubella, syphilis, toxoplasmosis or cytomegalovirus
may cause jaundice in the newborn. After birth, any bacterial or viral
infection in the baby may cause jaundice.How to check for jaundice and
what to doIt is best to check for jaundice during the day using natural
light. Hold the baby near a door or window.o     Starting from the face,
use your finger to gently but firmly press on the skin and quickly let
go.o   If the area that you pressed looks yellow the baby has jaundiceo
Work your way down from the face to the legs.If the yellow colour is only
on the face then the jaundice is quite mild.o    Make sure that baby has
sufficient fluids especially milk as it contains glucose necessary for
conjugation of bilirubin.o   Place the baby near a bright window during
the day.o   It is not really necessary to put baby in the sun as baby may
become over heated by the sun's rays. Alternately, the baby may become
chilled if there is a strong wind blowingo    If you are breast feeding it
is best that you do not take any ginger for the first 10 days after
delivery as ginger will make it harder for the liver to work on the
unconjugated bilirubin.If the face and body are yellow, then the jaundice
is quite high.o   You must take your baby back to the hospital
immediately. Don't waste time going to an outside clinic.o    Your baby
needs a blood test to determine the bilirubin level and immediate
treatment if the level is high.If at any time your baby is very sleepy
and refuses to feed even if she looks mildly jaundiced you must seek
medical attention immediately.Traditional treatmentThere is NO place for
traditional treatment. I have seen too many children with permanent brain
damage which is very sad as nowadays medical treatment is so effective in
preventing brain damage due to jaundice.Bathing the baby in kunyit water
is definitely not recommended because the skin becomes more yellow in
colour, therefore making it difficult to assess the true jaundice level
from looking at the skin. Do not give baby any herbal medicine as it may
interfere with the bilirubin conversion thereby increasing the levels of
fat soluble bilirubin and by the time the baby is taken to hospital, it
may be too late.Medical treatment in hospitalOnce your baby is admitted
to hospital, the paediatrician will take some blood to check the
bilirubin levels which, together with the baby's age and general
condition will determine the need for further treatment.Phototherapy is
the use of fluorescent lights to break down bilirubin in the skin making
it water soluble which can be easily excreted. It can be given
continuously or intermittently at 3-4 hourly intervals. During
phototherapy treatment the baby is naked except for the nappy in order to
expose as much of the skin to the lights. The eyes are covered with eye
pads to protect them. Baby must be given extra fluids to prevent
dehydration. It is normal if the baby develops skin rashes and has loose
green stools. Baby's bilirubin will be monitored regularly during the
treatment.Exchange blood transfusion is done to remove the bilirubin and
maternal antibodies from the baby's circulation and replacing it with
fresh blood from a donor. It is normally done if the bilirubin level
rises to a dangerous level which cannot be reduced by phototherapy or
there is severe Rhesus incompatibility.Remember if at any time you are
not sure about your baby's jaundice always check with the paediatrician.

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