Baby- Jaundice and phototherapy



JaundiceJaundice in the newborn baby is common and occurs in approximately half of all newborns. It is noticed as a yellow colouring of the skin and the whites of the eyes. Jaundice usually begins to fade by the end of the first week after birth without any problems. CausesNewborn Babies have more red blood cells than they need after birth and these excess red blood cells are gradually broken down in the first few days of the baby’s life .One of the end products from this process is bilirubin. Bilirubin is normally processed in the liver and is removed from the body in the urine and bowel motions.Prior to the birth the mother’s liver performs this function. Following the birth the baby’s liver takes a few days to take over this role adequately and as a result the baby’s body has some difficulty coping with the increased bilirubin level in the body .This means there can be a build-up of bilirubin in the blood and under the skin called “Jaundice”. The level of the jaundice is different with each baby but is normally mild and called physiological jaundice. Jaundice usually occurs first in the face and then moves to the chest, abdomen, arms and legs as the bilirubin level increases.To help prevent jaundice from occurring or getting worse you will be encouraged to feed your baby as soon as possible after birth and frequently after that. You can also place your clothed baby near the window in natural light as this helps the body deal with the extra bilirubin. But never in direct sunlight as your baby can get sunburntBabies more at riskJaundice can occur in all newborns; however some babies are at greater risk of becoming jaundiced than others. For instance:Premature babiesBabies with an infectionBabies with bruisingBabies who have different blood groups or types from their mothers. This may result in antibodies developing and breaking down the baby’s red blood cells. There are too many red cells being broken down for the baby’s body to cope with. Health problems If the level of bilirubin in the blood increases to a very high level, it can harm parts of the brain that are used for hearing, thinking and control of movement (called kernicterus). Kernicterus may result in deafness and physical and intellectual disability. The bilirubin level that is harmful is dependent on how mature and how well your baby is. A large, full term, healthy baby can have higher levels without problems, compared to a sick or premature baby. To prevent any chance of health problems happening we treat moderate levels of jaundice as this stops the bilirubin level from rising to a dangerous level. The level of jaundice is assessed carefully by the midwife and your doctor. A Blood test maybe necessary to measure the bilirubin level (SBR). TreatmentModerate jaundice is treated with bright fluorescent/ bluish coloured lights called phototherapy. These lights break down the bilirubin in the skin and make jaundice fade. Your baby may be placed in a nappy under lights (overhead phototherapy) or on a blanket of fiberoptic lights (biliblanket).Overhead phototherapy treatment is normally carried out in your hospital room. You are encouraged to continue to care for your baby with the help of your midwife. If your baby is placed under phototherapy a blood test may be taken at least once each day to check the level of bilirubin in their blood. The bilirubin level will usually decrease every day with the treatment. The phototherapy may sometimes cause your baby to have brown coloured urine and loose brown/green bowel motions. These are signs that the treatment is working and the bilirubin level is falling. Your baby should be encouraged to feed every three to four hours as this also helps to decrease the jaundice.Babies can be sleepy when they are moderately jaundiced and may not feed well. We encourage you to ask for help from the midwife if your baby needs more time than usual to feed. You will also need to tell your midwife if your baby is not feeding at least every four hours.Each time your baby is fed, their temperature should be checked. A baby’s temperature is normally between 36.5 and 37.2 degrees Celsius. It is important to check that your baby does not become hot or cold under the phototherapy lights. If they are on a biliblanket you may need to change the amount of clothes or number of blankets on your baby depending on their temperature. A protective mask will also be placed over your baby’s eyes to shield them from the bright lights if they are having overhead phototherapy. The eye mask should be removed during feeds to encourage eye contact between you and your baby.It is essential that your baby remains under phototherapy lights for as much time as possible each day. Please try to only take them out from under the overhead phototherapy lights for feeds. When on a biliblanket, your baby can remain on the biliblanket while feeding.Jaundice often takes about two weeks to disappear. If your baby is still jaundiced at three weeks please see your baby’s doctor.Please speak to your Doctor or Midwife if you need more information or have any concerns. ................
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