Understanding Newborn Jaundice

What Newborn Jaundice Is 0:00

Hey friends, it's Dr. Rott with the Dog and the Fam. I'm going to talk to you a little bit about jaundice in the newborn period today. Jaundices when baby skin starts to look yellow. Baby skin begins to like yellow because it got a pigment called bilirubin that causes the skin to turn yellow temporarily. It starts in the sclera or the whites of the eyes and then usually proceeds downward. So the higher the number, the lower you'll notice it on their body until it, you know, it's all the way down to their little toes.

Any jaundice in first 24 hours should make us perk up and pay attention. That's not normal. It needs to be evaluated quickly. But after the first twenty four hours, baby is trying to deal with all of this extra blood that it has in it from delayed cord clamping and such, and it doesn't have all of its enzymes and excretory processes fully online yet. So those things just need a little bit longer to come on. In addition, baby is learning to feed, hopefully at the breast, but if baby's learning at a bottle, we still may not have just really vigorous feeding

Why Jaundice Happens After Birth 0:58

in the first few days of life. It takes them a while to figure that out. And one of the ways that we excrete that particular byproduct of red blood cell metabolism is through urine and through stool. So we want baby to be eating well, having urine output and having stool output that will help to decrease the bilirubin. Now, why do we care about bilirobin so much? Well, I'll tell you why. It's because when it gets very high, it can cross the blood brain barrier. That means it goes from the Bloodstream into the brain and it cause a condition we call kernicterous, which can do bad mischief to the Brain, including cause I'm not telling you that to scare you.

I have not seen that occur in my entire career over 20 years. Because we have a plan, because we monitor babies and we notice when they're yellow. And if they need it, we put them under the blue lights, which I'm sure you've seen around, or maybe your baby has had this already. So the Blue Lights actually magically transform the bilirubin in the skin to a form that we can more easily excrete.

When Jaundice Becomes Concerning 2:06

What we'll do is watch how old is your Baby in hours? Do they have any risk factors? And risk factors are like they were premature or they have a different blood type. Mom has O, baby has AB or AB. Um, mom has an antibody and that sets baby up for a potential problem where the antibodies are attacking baby's blood cells. Blood cells are being ruptured and baby is needing to metabolize more blood sells than it can keep up with. So I don't want to get too far down into the weeds, but I just want give you a little bit of a peek into that thought process of why we respond to jaundice the way that we do.

Now, I do not want cause alarm, there are a few kinds of jauntice that are serious. Main one is biliary atresia. So if your baby doesn't have normal anatomy in its bile system between its liver and gallbladder, that can cause a really important problem that needs surgery pretty quickly. And those babies tend to have a different type of bilirubin elevation.

Treatment With Blue Light Therapy 3:14

You'll be asked about indirect bili. it's more of a obstructive pattern than just a we're not metabolizing blood cells quickly enough. And so your care provider will check for that and send you to a specialty center if that is what's needed. Now we call it an ABO setup when mom and baby have different blood types. So mom has an O in it, so if mom had an o blood type and the baby has A's and B's in, right? So a baby's AB. That's the kind of setup where mom's blood can react negatively toward baby blood.

And then we have that problem where baby is lysing or rupturing these blood cells needing to metabolize it and causing a backup increase of bilirubin. All right. We, um, we check for antibodies in that case. And we call it ISO immune. iso immunization here.

Risk Factors and Blood Type Incompatibility 4:10

So we're looking for a immune reaction against the baby's blood. All right, all of that there. Now I want to say one thing about a super benign kind of jaundice that can last a long time as well. And that is breast milk jauntice, not breastfeeding jaunice. There's a little difference here, so breast feeding takes a while. Feeding's not going great. It's little bit pokey. And we have some jaundice, but it's not usually super high levels. Okay. This is also benign breast, breast milk jauntice occurs in some babies who are just more prone to jaunce.

And maybe later on, we'll find out that they have a tiny little, usually not clinically significant abnormality in a genetic thing for their liver. Kind of really doesn't matter. Your baby's fine. I met a lady actually not that long ago who was breastfeeding her second baby.

Serious Causes Like Biliary Atresia 5:04

He was pretty yellow and he was two weeks old and some folks were really worried about it. But I was feeling like, Oh, this lady's wasted all of her worry because this baby just has breast milk jaundice. It wasn't high enough to worry. it's just lasting longer than average. He was waking up, he was feeding, peeing, pooping, gaining weight, doing everything else really beautifully. So if your baby is feeding and waking and peeping and poopin and not being extremely fussy or lethargic and you still have a little bit of a yellow baby at two weeks of age, that is probably what you're dealing with.

Breast Milk Jaundice and Reassurance 5:38

Talk to your doctor always. Of course, make sure it's not something more serious. But that's my short take on newborn jaundice. the regular kind, the bad kind and the irregular, but not so bad. All right. Tell me your story. Hit me up with your questions. Do you have questions about this? If you had some scares, had to go back to the hospital for lights, all of that's very common. Your baby is just right as rain. Alright, I'll see you on another topic. Thanks. Bye.