Jaundice in newborn babies

Jaundice in newborn babies

By Deborah Worthington, RN, CPN
Registered Nurse, Swedish Pediatric Specialty Care

As a new parent, you’re understandably eager and excited to leave the hospital and settle into your new routine with your baby. Sometimes, that routine is delayed due to the baby’s blood test confirming hyperbilirubinemia, also known as jaundice.

Jaundice in newborns is caused by an excess of red blood cells. Jaundice is seen as a yellow color to the skin, appearing first at the head (skin and sclera – or “whites of the eyes”) then progressing to the feet. As it decreases, it lessens in reverse. Before birth, the placenta removes bilirubin from the baby’s system; after birth, the baby’s liver takes over. In breast-fed babies, an imbalance between mother’s milk supply and baby’s feeding can lead to a higher-than-expected bili level. In addition to ensuring the baby is feeding well and having enough wet/stool diapers, phototherapy or “bili lights” may be needed. Bili lights help speed up the process by breaking down the bilirubin in the skin.

For phototherapy, your baby will be placed in a crib, under lights wearing just a diaper and protective eye mask. The baby’s temperature and bili level are monitored at intervals determined by your MD/ARNP.  As baby seems to be “just sunbathing,” the phototherapy may add to that “hurry up and wait” feeling, but the time under lights is necessary to decrease the bili level. To maximize treatment, baby is brought out only for feeds – usually limited to 30 minutes at a time. The eye mask can be removed during feeds to increase eye contact and bonding with parents. As part of treatment, nurses will also track baby’s “ins and outs” or time/volume of feeds and the wet/stool diapers as the stool is another way that the bilirubin is removed from baby’s system. Parents are often cautioned that the lights can make the stool appear red and does not necessarily indicate that the baby is bleeding.

Depending on your baby’s needs, additional “bili level” blood tests may be order to determine progress and length of treatment – usually just one to two days. Depending on the results, your practitioner may determine that the lights can be switched off and that baby can have a “rebound bili” blood test done after a few hours (to check for an increased bili level or if baby can be discharged home to follow up with your pediatrician.

You’ll be encouraged to continue to track your baby’s feeding habits and diapers, as well as continued signs of lethargy.  As the bilirubin level decreases, the baby’s feeding, alertness and activity should increase; stool diapers may continue to appear dark for a while. You can check baby’s skin color and the whites of the eyes for improvement – remember that jaundice improves from feet to head. Before you know it, you’ll be in your new routine as a parent of a newborn.
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