Jaundice Health Article

Treatment

Neonatal jaundice usually requires only observation. The infant may stay in the hospital for an extra day or return within the next few days for an examination. However, jaundice in a preterm baby may require intensive care. As the infant's liver matures and the excess blood cells are removed, the jaundice disappears. The child may be given additional fluids, possibly intravenously, to help remove the bilirubin. Frequent feedings lead to more frequent stools, which reduces the reabsorption of bilirubin from the intestines into the blood. Breast milk usually is considered superior to water or formula for relieving jaundice because breast milk produces stool with every feeding, thereby excreting bilirubin. Breastfeeding should not be discontinued because of neonatal jaundice.

If an infant's bilirubin levels are quite high or rising rapidly, phototherapy can prevent complications. The child is undressed and placed in a lighted incubator to stay warm. A high-intensity, cool, blue-fluorescent light is absorbed by the bilirubin and converts it into a harmless form than can be excreted in the bile and urine. An eye shield protects the baby's eyes. The infant is removed from the incubator for feeding. Other photo-therapy methods—such as a fiber optic bilirubin blanket—incorporate the light into a blanket so that the child can be breastfed during treatment or treated at home. Phototherapy is continued until bilirubin levels have returned to normal, usually within a few days.

Side effects of phototherapy may include:

• loose stools
• rash
• dehydration
• sleepiness
• disinterest in breastfeeding

If bilirubin approaches a dangerous level, an exchange blood transfusion is used to rapidly lower it. A catheter is placed into the umbilical vein at the cut surface of the umbilical cord, and the newborn's blood is replaced with an equal volume of new blood. Rh incompatibility also may be treated by exchange transfusion.

Antibiotics may be used to prevent or treat a suspected infection in jaundiced infants. Babies with very severe jaundice have their hearing tested and are monitored for several months.

Surgery for biliary atresia must be performed within the first few weeks of an infant's life to prevent fatal liver damage. About 40–50 percent of infants with biliary atresia are candidates for replacement bile ducts leading from the liver into the intestine. Called the Kasai procedure or hepatoportoenterostomy, the obstructed ducts are replaced with sections from the infant's intestines. Infants with a duct obstruction within the liver itself usually require a liver transplant by the age of two.

Prolonged breast-milk jaundice may require breast-feeding to be halted for a few days until bilirubin levels drop. The breasts should be pumped in the interim so that the mother does not stop producing milk and breast-feeding can be resumed.

Prognosis

Neonatal jaundice disappears after one to two weeks. It may last slightly longer in breastfed infants. The jaundice does not harm the infant in any way, and breastfeeding should not be discontinued.

Severe untreated jaundice leading to kernicterus may result in the following:

• mental retardation
• cerebral palsy
• deafness
• death

Untreated biliary atresia leads to biliary cirrhosis, a progressive, irreversible scarring of the liver, by about two months of age. About 50 percent of bile duct replacement surgeries are successful, and the jaundice usually disappears within several weeks. Despite this success, the liver damage often progresses on to cirrhosis.

Breast-milk jaundice, resulting from a reaction to a breast milk component, is not dangerous. The baby's liver soon adapts to the problem and the jaundice disappears.

Prevention

In 2004 the American Academy of Pediatrics issued revised guidelines for identifying and managing neonatal jaundice. They recommend:

• that all newborns be assessed for their risk of developing severe jaundice, including measuring bilirubin levels before hospital discharge
• a follow-up visit occur within three to five days after birth when bilirubin levels are likely to peak
• breastfeeding a newborn at least eight to 12 times per day, since effective breastfeeding significantly reduces the risk of hyperbilirubinemia
• that parents be provided with written and oral information about the risks of neonatal jaundice

In cases of known Rh incompatibility, the mother is given an injection of RhoGAM, an immune globulin preparation, at about 28 weeks of pregnancy and again immediately after the child's birth. This destroys any Rh-positive fetal blood cells in the mother's circulation before her immune system can produce antibodies against them.