The first step is to encourage the jaundiced baby to nurse more often at least 10 to 12 times in 24 hours and more effectively check to see if baby is latched-on and sucking well to reduce bilirubin levels as soon as possible. Skin-to-skin contact and use of breast compression during feeds can help encourage the baby who is slow to feed actively.
Seek skilled breastfeeding help early if you encounter difficulty. If the baby is not breastfeeding actively despite this help, milk expression may be needed to initiate adequate milk production and possibly to supplement breastfeeding. Feeding methods such as a spoon, cup, eyedropper, syringe or an at-breast supplementer, in preference to the bottle, can facilitate transition to full breastfeeding.
Phototherapy is the most frequently used treatment when bilirubin exceeds thresholds. The baby remains under the lights continuously for a day or two, although parents may remove the baby from the lights for feedings. One of the problems with phototherapy is that it interferes with mother and baby being together and interacting freely in the first days of life. In hospital, it may be possible for the phototherapy unit to be set up in your room, so that you can talk to, touch and breastfeed your baby frequently.
If the baby is hospitalized but you are not, you can stay with your baby in the nursery. If treatment is needed after release from hospital, your doctor might order a home phototherapy unit. Putting the baby in indirect or direct sunlight as an alternative to phototherapy is no longer recommended to treat jaundice. Indirect sunlight is not reliable and direct sunlight can cause a dangerous increase in body temperature and sunburn.
Physicians used to suggest routinely substituting formula for hours or supplementing breastfeeding to bring down bilirubin levels. This course of action is no longer routine but may be suggested when phototherapy is not readily available or deemed unduly expensive.
It may be used, often in conjunction with phototherapy, when high bilirubin levels must be reduced urgently. Interrupting breastfeeding can lead to early weaning and deprive the baby of the many benefits of breastfeeding. If supplementation is necessary, pumping is critical for the mother to build up and maintain her milk supply. A baby whose tummy is filled with water or sugar water will nurse less often and thus is more likely to have problems with jaundice.
The American Academy of Pediatrics suggests that pediatricians discuss several treatment options with parents. Here are some questions to consider:. If a doctor suggests that you stop breastfeeding and give your baby formula, ask about using phototherapy to treat the jaundice while you continue to breastfeed.
In most babies, jaundice is short-lived and harmless. For sure, there may be times when it is necessary to treat the jaundice, but in these situations, parents and health professionals should remember that frequent breastfeeding in the first days of life helps ensure successful breastfeeding in the weeks and months to come. The goal is a healthy baby who continues to breastfeed. Babies who are latched-on well get more milk from the breast.
Baby should be facing mother and pulled in close to her body. The baby opens her mouth wide as she goes onto the breast and takes a large mouthful of breast tissue. If baby is not latched-on well, take the baby off the breast and try again. Check for effective sucking.
The baby moves her jaw, not just her lips, as she sucks. After the initial let-down, baby will swallow after every one or two sucks. This active swallowing should continue for ten to twenty minutes per breast. As the new blood won't contain bilirubin, the overall level of bilirubin in your baby's blood will fall quickly. Your baby will be closely monitored throughout the transfusion process, which can take several hours to complete. Any problems that may arise, such as bleeding, will be treated.
If the level of bilirubin in your baby's blood remains high, the procedure may need to be repeated. If jaundice is caused by an underlying health problem, such as an infection, this usually needs to be treated. If the jaundice is caused by rhesus disease when the mother has rhesus-negative blood and the baby has rhesus-positive blood , intravenous immunoglobulin IVIG may be used.
IVIG is usually only used if phototherapy alone hasn't worked and the level of bilirubin in the blood is continuing to rise. Learn more about IVIG treatment for rhesus disease. Page last reviewed: 04 September Next review due: 04 September Phototherapy Phototherapy is treatment with a special type of light not sunlight. There are 2 main types of phototherapy. This involves using more than one light and often a fibreoptic blanket at the same time. Treatment won't be stopped during continuous multiple phototherapy.
Exchange transfusion If your baby has a very high level of bilirubin in their blood or phototherapy hasn't been effective, they may need a complete blood transfusion , known as an exchange transfusion. Your baby's blood will be tested within 2 hours of treatment to check if it's been successful. Most cases show up two to three days after birth and are caught by in-hospital screens for babies , while others can appear later. Jaundice usually goes away on its own or sometimes with mild treatment with no ill effects.
It usually lasts a week to 10 days, sometimes longer for premature babies. Jaundice in a newborn baby is caused by excess levels of bilirubin, a condition known as hyperbilirubinemia.
Bilirubin is an enzyme that's produced in the blood when the body breaks down old red blood cells. Since a newborn's liver is underdeveloped, the bilirubin often doesn't get eliminated as efficiently, which can cause the skin, and sometimes the whites of the eyes, to turn yellow. Although there isn't anything you can do to prevent jaundice, it's important to watch for the telltale signs and symptoms, especially since the condition may not develop until after you bring your baby home from the hospital.
That way, you can seek treatment if necessary. The American Academy of Pediatrics AAP recommends babies be assessed by a pediatrician for jaundice again at 3 to 5 days of age.
This is the time when bilirubin levels are the highest. Jaundice often appears on the face first and then spreads to the rest of the baby's body, including the chest, tummy, arms, legs and whites of the eyes.
A good way to check is to place your baby in natural sunlight or under fluorescent lights and gently press her forehead and nose with your fingers. If the skin appears yellow where you made the impressions, call your pediatrician. The doctor will probably want to examine your baby and take a blood sample to look at the bilirubin levels in her blood.
Jaundice can be harder to see in babies with darker skin. In darker-skinned babies, the yellowing may be more visible on the palms of the hands and soles of the feet, so check there. Babies born prematurely before 37 weeks or at a low birth weight. Babies who lost a lot of weight right after delivery or had a lot of bruising or bleeding under the scalp related to labor and delivery.
Babies with a parent or sibling who had a high bilirubin level and received light therapy. It takes time to get the hang of it.
If there are moderate to high levels of bilirubin detected in your baby, you may be advised to expose her to sunlight or another type of phototherapy at home, which helps to break down the enzyme, making it easier for the body to eliminate. However, because of newborns' substantial risk of sunburn with direct sunlight exposure, doctors these days are more likely to offer treatment with phototherapy which places the baby under a certain type of bright lamp or a special blanket or pad.
You may also be told to feed your baby as often as possible, without overfeeding, to encourage frequent bowel movements. That will also help get rid of the excess bilirubin, which gives stools a brownish-yellowish color. In the most extreme form of jaundice, when bilirubin levels are abnormally high, the enzyme can build up in the brain.
Left untreated, very severe jaundice can lead to an extremely rare condition called kernicterus, which can result in permanent brain damage. Some hospitals are taking extra measures to monitor the levels of bilirubin in babies' blood through blood tests and follow-up visits to ensure that these very uncommon instances of kernicterus are not missed.
Phototherapy treatment also called light therapy or bili lights.
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