Bilirubin

aundice 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.

Bilirubin

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 jaundice

Excessive 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 do

It 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 jaundice

o 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 blowing

o 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 treatment

There 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 hospital

Once 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.


Bilirubin