Newborn Jaundice

Spending a week in the hospital with our newborn has forced me and my husband to revisit something we haven't had to think about since medical school: newborn jaundice.

Newborn jaundice occurs when a baby's bilirubin level is high. Bilirubin is a breakdown product of red blood cells. It's a yellow pigment that causes the skin and eyes to look yellow.

Bilirubin levels can be high if the number of red blood cells are being recycled more quickly, or if the body can't process the bilirubin well. In a newborn, this can happen for a number of reasons.

There's a nice discussion of this at http://www.nim.nih.gov/medline/ency/article/001559.htm.

In our case, the most likely factors are

* Significant bruising during birth.
* ABO compatibility (the woman carrying the baby has type O blood, and the baby does not)
* The baby's liver is immature, and can't do what it needs to do to eliminate the bilirubin.

So the baby is treated with phototherapy. Special blue lights shined on the baby while she's in an incubator type of bassinette help to break down the bilirubin in the skin. The bilirubin is converted into forms that are water soluble (photorubin and lumirubin) and more easily eliminated and don't have to rely on the liver for processing.

Light therapy for this condition came about due to some astute observations. In 1958, the staff at a London hospital noticed the babies in a newer, well-lit nursery had less jaundice than the babies in the older, more dimly lit nursery. Further studies confirmed this, and this became a standard treatment.

In severe cases of neonatal jaundice, a complete transfusion of the baby's blood is needed.

The feared complication if the bilirubin level goes too high is kernicterus. The bilirubin gets deposited in certain parts of the brain, causing damage. The baby can then have abnormal writhing movements called athetosis, deafness, eye movement problems, and stained teeth enamel. See http://www.kernicterus.org.

Our baby is getting the blue light special all day today. Her bilirubin levels hover in the teens, indicating her red blood cells are still breaking down. Hopefully, she might be able to go home in the next few days. The waiting is the hardest part.