![]() ![]() The American Academy of Pediatrics recommends that, if possible, breastfeeding be continued. This is done in consultation with the neonatologist.Īdequate hydration with breastfeeding or pumped breast milk. Under special circumstances, an exchange transfusion may be needed to replace the baby's blood with fresh blood in an attempt to rapidly decrease the bilirubin level. Blood levels of bilirubin are checked every 6-12 hours to ensure that the phototherapy is working. The baby's eyes must be protected and the temperature monitored during phototherapy. Phototherapy may take several hours to begin working and is used throughout the day and night. During phototherapy, the baby is placed under ultraviolet light. The goal is to keep the level of bilirubin from increasing to dangerous levels while minimizing any negative effects of the treatment. Treatment depends on many factors, including the cause of the hyperbilirubinemia and the level of bilirubin. Reticulocyte count determines the number of young red blood cells, which is an indication of red blood cell production.īlood type and testing for ABO or Rh incompatibility (Coomb's test) Red blood cell count may be used to determine if the baby has too many or too few red blood cells. A blood test can determine if the bilirubin is bound with other substances by the liver so that it can be excreted (direct), or is circulating in the blood circulation (indirect). Later appearance of jaundice in the second week, is often related to breast milk feedings, but may have other causes.ĭiagnostic procedures for hyperbilirubinemia may include:ĭirect and indirect bilirubin levels. When jaundice appears toward the end of the first week, it may be due to an infection. The physician will usually rely on a bilirubin tool or graph to decide when the level of bilirubin becomes dangerous as infants who are a few days old can tolerate higher levels of bilirubin compared to an infant who is less than 48 hours old. When jaundice appears on the second or third day, it is usually "physiologic" or related to dehydration. Jaundice appearing in the first 12-24 hours can be serious and may require early treatment. The timing of the appearance of jaundice helps with the diagnosis. Jaundice may be related to prolonged liver dysfunction due to infection and other factors. Jaundice related to inadequate liver function. Increased hemolysis can also occur if the baby is bruised or develops a hematoma during delivery. Jaundice may occur if there is an increase of red blood cell breakdown (hemolysis) such as that seen when there is a mismatch of maternal and fetal blood type, resulting in ABO incompatibility or hemolytic disease of the newborn (Rh disease). Breastfeeding can usually continue or only be interrupted briefly. Breast milk jaundice is thought to be caused by a substance in the breast milk that increases the reabsorption of bilirubin through the intestinal tract. It peaks about two weeks of age and can persist up to three to twelve weeks. About 2 percent of breastfed babies develop jaundice after the first week. Once effective breastfeeding is established, this problem will resolve.īreast milk jaundice. While common in full term infants, premature infants and late preterm infants are more susceptible to this problem because they may have uncoordinated suck as well as easy fatigability. Since bilirubin is eliminated in the urine and stool, decreased urination and infrequent stools result in a buildup of bilirubin. During the first few days of breastfeeding when the maternal breast milk supply is low and the baby is having trouble latching and feeding, the baby may become dehydrated. This will usually resolve by the first week of life.īreastfeeding failure jaundice. Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete bilirubin in the first days of life due to the immaturity of the liver. There are several causes of hyperbilirubinemia and jaundice, including the following: During pregnancy, the placenta excretes bilirubin but when the baby is born, the baby's immature liver must assume that role. The adult liver converts unconjugated bilirubin into a conjugated form, that be excreted. ![]() Bilirubin is a natural byproduct produced when red blood cells breakdown. ![]()
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