children s health issues
Jaundice in the Newborn
Treatment of Jaundice in Newborns
When a disorder is identified, it is treated if possible. High bilirubin levels themselves may also require treatment. Physiologic jaundiceusually does not require treatment and resolves within 1 week. For newborns being fed formula, frequent feedings can help prevent jaundice or reduce its severity. Frequent feedings increase the frequency of bowel movements and thus eliminate more bilirubin in stool. The type of formula does not seem to matter. Breastfeeding jaundicemay also be prevented or reduced by increasing the frequency of feedings. If the bilirubin level continues to increase, rarely, infants may need to be supplemented with formula. Inbreast milk jaundice,mothers may be advised to stop breastfeeding for only 1 or 2 days and give their newborn formula and to express breast milk regularly during this break from breastfeeding to keep their milk supply up. Then they can resume breastfeeding as soon as the newborn's bilirubin level starts to decrease. While breastfeeding, mothers are usually advised not to give the newborn water or water containing sugar because doing so may decrease how much milk the newborn drinks and may disrupt the mother's milk production. However, breastfed infants who are dehydrated despite efforts to increase breastfeeding may need additional fluids. High unconjugated bilirubin levelsmay be treated with Exposure to a special light (phototherapy) Exchange transfusion Phototherapy uses bright light to change bilirubin that has not been processed by the liver into a form that can be eliminated rapidly from the body by excretion in the urine. Blue light is the most effective, and most doctors use special commercial phototherapy units. Newborns are placed under the lights and are undressed to expose as much skin as possible. They are turned frequently and left under the lights for variable periods of time (typically about 2 days to a week) depending on how much the bilirubin levels in the blood need to be lowered. Phototherapy can help prevent kernicterus. To determine how well the treatment is working, doctors periodically measure bilirubin levels in blood. Skin color is not a reliable guide. This treatment is not effective for all types of hyperbilirubinemia. For example, phototherapy is not used for jaundice caused by Cholestasis in the Newborn . This treatment is sometimes used when unconjugated bilirubin levels are very high and phototherapy is not sufficiently effective. An exchange transfusion can rapidly remove bilirubin from the bloodstream. A small amount of the newborn's blood is gradually removed (one syringe at a time) and replaced with (exchanged for) an equal volume of donor blood. The procedure usually takes about 2 hours. Exchange transfusion may also remove antibodies against red blood cells if the hyperbilirubinemia is due to blood type mismatch between mother and infant. Exchange transfusions may need to be repeated if bilirubin levels remain high. Also, the procedure has risks and complications, such as heart and breathing problems, blood clots, and electrolyte imbalances in the blood. The need for exchange transfusion has decreased since phototherapy has become so effective and since doctors have become better able to prevent problems resulting from incompatible blood types. 