Dr. Carlos Ernesto Scheel Alvarez
At least half of babies born at due date have some jaundice (look yellow), and if they are premature the rate is even higher. Most of the time this is something physiological and temporary, and only in few occasions it is necessary to intervene. Jaundice comes from bilirubin that is caused mainly by degradation of red blood cells. Bilirubin produced is indirect or not conjugated, and later is conjugated in the liver and excreted by bile to the small intestine to later be eliminated in feces. If there is a pathology that increases degradation of red blood cells such as hemolysis due to Rh group or subgroup incompatibility between mother and child, bilirubin can increase significantly and not be physiological. No benefit of bilirubin is know; to the contrary, if it is too high it may cause kernicterus in the newborn child; this is a yellow coloring of the basal brain ganglia that causes lethargy, convulsions, deafness, etc. and even death. Most babies that become jaundiced physiologically do so the 2nd day of life, and it disappears before they are one week old. Mother’s milk may collaborate to increase jaundice, as the amount of milk ingested through breastfeeding compared to a baby fed with formula can be less, reducing intestinal transit and therefore excretion of bilirubin. In spite of this, breastfeeding is the best food for a baby, and it should be exclusive.
A jaundiced child must be evaluated by a doctor, notwithstanding when or how much jaundiced he is. It is extremely difficult and risky to dismiss pathological jaundice through simple observation of a baby. Alert signals are that the baby becomes jaundiced the initial 24 hours of life, that it vomits, is lethargic, little appetite, etc. or that a baby born on the due date is yellow after 8 days of life or 14 if he is premature. If so, blood tests must be taken to determine (if not previously known) blood types of the mother and child, and hemolysis signs (direct coombs, reticulocyte count, peripheral swab). Indirect hyperbilirubinemia due to blood incompatibility is suspect knowing the blood type of mother and child. It may be caused by groups incompatibility (O,A ,B ,AB ), Rh (negative or positive) or by subgroup. There is more danger if the mother is O blood type and the baby is A, B, or AB or is the mother is Rh negative and the baby is Rh positive. If there is pathological jaundice, with hemolysis, and not due to group or Rh, by exclusion it is caused by subgroup (McGovern, Kell, etc). Other less common causes of non conjugated hyperbilirubinemia are infections, hyperthyroidism or hematoma (cephalus hematoma, brain hemorrhage).
Most babies will not require major treatment. If an experimented person examines the baby and confirms jaundice is not extended (only the face and not the first day of life), medical history can discard that it is due to incompatibility that causes hemolysis and if the baby is considered normal after a physical the mother is recommended to watch the child, and give notice if jaundice increases significantly and sunbathe the baby. There is controversy about the latter being beneficial or not. The idea is that just like phototherapy (blue light) causes photoisomerization (changes composition) of bilirubin when exposed to light through skin, sunbathing causes bilirubin to be easily excreted through bile without need to be conjugated. Depending on geographical location, in tropical areas it is recommended to place the naked baby wearing only a diaper, behind a window for 30 to 45 minutes at 9 or 9 in the morning and in less hot zones, at 10 or 11 in the morning, for a week. But if jaundice is pathological, the child must be placed in phototherapy several days depending on the case, and if bilirubin does not decrease a complete ex blood transfusion must be performed. It consists in removing the baby’s blood through an umbilical catheter to be hemolyzed, and infuse blood compatible with the mother’s so hemolysis is reduced and there is no risk of kernicterus.
The message is that newborn jaundice is common, almost never requires treatment except for sunbathing, but should always be evaluated by a doctor with experience in managing hyperbilirubin as the damage caused by kernicterus is irreversible.