Two-day old baby with a good case of jaundice.
Jaundice is an extensive topic, one that student midwives need to research on their own. Here, I will share the bare basics, merely enough to act as a springboard to the enormous amount of information out there. Even as an experienced midwife, when I have babies with jaundice, I head onto the Net to check for new information and to reinforce/remind me what I have already learned. (The article linked to the word "jaundice" has an extremely comprehensive, medically-oriented, but understandable article. Bookmark it.)
Jaundice can be benign or serious. The causes are generally the distinction between the two, but even normal jaundice can be exacerbated by outside influences. Jaundice that occurs within the first 24 hours is cause for serious investigation.
Benign types of jaundice include:
Normal physiologic jaundice - When the baby's liver is too immature to keep up with the bilirubin that's breaking down in the blood.
Breast milk jaundice - Breast milk is thought to have properties that inhibit the breakdown of bilirubin, causing some babies to develop jaundice between four and seven days in that first week and lasting several weeks. From what I have found, there hasn't ever been a case of kernicterus (Kernicterus is a form of brain damage caused by excessive jaundice) with breast milk jaundice.
Breastfeeding jaundice - This mimics normal physiologic jaundice but seems to abate once the mother's milk is in. Too often, babies are taken off the breast for a couple of days, waiting for the milk to come in, before allowing the baby with a higher bili count to nurse again. Of course, we know that delaying nursing delays the milk coming in and interferes with mother and baby togetherness.
The more serious types of jaundice can be:
ABO Incompatibility - When the mom has the blood type O and the baby does not.
Birth trauma - Bruising that occurs during the birth, including the cranial suffusion caused by a shoulder dystocia, can set the baby up for serious jaundice.
Premature babies - The liver is what helps process the bilirubin, so in a premie, the liver is already immature and unable to keep up with the needs of their new neonatal body; most premature babies deal with jaundice after birth.
Bilirubin is measured in the blood by any or all of these tests:
The fear of a bili level getting too high is kernicterus (mentioned briefly above). Kernicterus can cause brain damage and even death in babies. One serious issue with kernicterus is there is no absolute number when a baby topples into it; each baby has their own threshold, meaning some babies will be treated needlessly, whereas others should have been treated earlier. Guidelines do exist regarding when to initiate treatment with Bili-Lights (phototherapy), but I have found that each hospital and even each doctor seems to have their own numbers in mind. (I am sure that, as with all us birthy folks, they are a product of their experiences and if they had a baby with kernicterus at a lower-than-standard number, they might act more conservatively than the recommendations suggest.)
Treatment for serious jaundice is putting the baby under bili-lights (pic below), sometimes for days, until the bili level drops to a safer number.
The bili-lights help to break down the bilirubin in the system, lowering the numbers faster than if left alone. (This is an extremely simplistic explanation.) The set-up seen above has been used for decades. Today, with a bili count in the moderate range, the doctor might prescribe a BiliBlanket instead. Both the blanket and overhead lights can now be done at home as long as the baby isn't terribly ill; insurance would rather pay the lower cost of home bili treatment anyway.
As I said, please use this minimal information as a beginning to learn about newborn jaundice. This is, in no way, enough information for you to make a decision about you and your baby.
But, I loved the picture at the beginning and wanted to share it. I haven't gotten a really great pic of a yellow baby; glad I have one now.