children s health issues
Jaundice in the Newborn
Evaluation of Jaundice in Newborns
While newborns are in the hospital, doctors periodically check them for jaundice. Jaundice is sometimes obvious by the color of the whites of the newborn's eyes or skin. But most doctors also measure the newborn's bilirubin level before discharge from the hospital. If the newborn has jaundice, doctors focus on determining whether it is physiologic and, if not, identifying its cause so that any dangerous causes can be treated. It is particularly important for infants to be evaluated for serious disorders if jaundice persists after 2 weeks of age. In newborns with jaundice, the following symptoms are cause for concern: Jaundice that appears on the first day of life Jaundice in newborns over 2 weeks old Lethargy, poor feeding, irritability, and difficulty breathing A fever Doctors are also concerned when bilirubin levels are very high or are increasing rapidly or when blood tests suggest that the flow of bile is reduced or blocked. Newborns with warning signs should be evaluated by a doctor right away. If the newborn is discharged from the hospital on the first day after birth, a follow-up visit to measure the bilirubin level should done within 2 days of discharge. Once at home, if parents notice that their newborn’s skin or eyes look yellow, they should contact their doctor immediately. The doctor can decide how urgently to evaluate the newborn based on whether the newborn has any symptoms or risk factors such as prematurity. Doctors first ask questions about the newborn’s symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done. Doctors ask when the jaundice started, how long has it been present, and whether the newborn has other symptoms such as lethargy and poor feeding. Doctors ask what, how much, and how often the newborn is being fed. They ask how well the newborn is latching onto the breast or taking the nipple of the bottle, whether the mother feels that her milk has come in, and whether the newborn is swallowing during feedings and seems satisfied after feedings. The doctor also asks about stool color. Information about how much urine and stool the newborn produces can help doctors evaluate whether the newborn is being fed enough. Stool that is pale and not the normal yellow-gold color suggests there may be Cholestasis in the Newborn . Doctors ask the mother whether she had infections or disorders during pregnancy (such as Diabetes During Pregnancy ) that can cause jaundice in the newborn, what her blood type is, and what medications she has been taking. They also ask whether family members have had any of the hereditary disorders that can cause jaundice. During the physical examination, doctors check the newborn's skin to see how far jaundice has progressed down the body (the lower down on the body that jaundice is visible, the higher the bilirubin level). They also look for other clues suggesting a cause, particularly signs of infection, injury, thyroid disease, or problems with the pituitary gland. Bilirubin levels are measured to confirm the diagnosis of jaundice, and tests are done to determine whether elevated bilirubin, if present, is conjugated or unconjugated. Levels may be measured in a sample of blood or by using a sensor placed on the skin. If the bilirubin level is high, other blood tests are done. They typically include Hematocrit (the percentage of red blood cells in blood) Examination of a blood sample under a microscope to look for signs of red blood cell breakdown Reticulocyte count (the number of newly formed red blood cells) Direct Coombs test (which checks for certain antibodies attached to red blood cells) Measurement of different types of bilirubin Blood type and Rh status (positive or negative) of the newborn and mother Other tests may be done depending on results of the history and physical examination and on the newborn's bilirubin level. They may include culturing samples of blood, urine, or cerebrospinal fluid to check for infection, measuring levels of red blood cell enzymes to check for unusual causes of red blood cell breakdown, doing blood tests of thyroid and pituitary function, and doing tests for liver disease. 