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Common causes of deep jaundice
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Risks of deep jaundice
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Common causes of deep jaundice
Where does jaundice come from?
Is jaundice a problem?
Risks of deep jaundice
Treatment of newborn jaundice
Jaundice occurs in almost half of all normal full term babies. In preterm babies (those that have spent less than 37 weeks in the womb, also called premature babies), the incidence approaches 80%. So what is jaundice and why is so much attention paid to it?
Jaundice is a yellow colour of the skin and eyes, caused by the accumulation of a substance called bilirubin. Bilirubin comes in two flavours - conjugated and unconjugated. It is the latter that gets your baby's doctor excited.
Bilirubin is a product of the destruction of red blood cells. This is a natural, ongoing process, as the red blood cells have a normal life span of 120 days. The hemoglobin inside is degraded to bilirubin, and reaches the liver. The liver conjugates the bilirubin to a water soluble form that can be removed from the body in the urine.
Babies don't bother to do all this before birth. They simply dump the bilirubin across the placenta. After birth, however, this convenience is no longer available, and the baby's liver has to take up this task. While it gets its act together, bilirubin accumulates in the body. This is known as Physiological Jaundice of the Newborn.
While bilirubin in the skin makes the baby look yellow and sick, this is not really dangerous in itself. What worries the doctor is the possibility of brain damage, which occurs when the level of bilirubin rises very high in the blood. When bilirubin gets deposited in the brain, the baby can have permanent problems like deafness, seizures, weak muscle tone, and severe mental retardation. Very high bilirubin levels can cause death.
Jaundice usually becomes noticeable on the third day, when blood levels reach 5 milligrams per 100 milliliters. This appears as a yellow tinge to the face. Around this time, the liver starts functioning, and bilirubin levels fall, causing the jaundice to fade. If bilirubin continues to accumulate, jaundice appears on the chest, abdomen, and finally the feet.
How much bilirubin is dangerous? Earlier, a level of 20 milligrams per 100 milliliters was considered dangerous. In the last two decades, research has found higher levels to be safe in normal babies, and we are less aggressive about treating jaundice. Bilirubin toxicity occurs at lower levels of serum bilirubin in premature babies, babies who were asphyxiated at birth, and babies with infection or other diseases. These factors are considered when making treatment decisions for a baby with jaundice.
Drugs do not have much of a role to play. The mainstay of therapy is phototherapy - the exposure of the baby's unclothed body to strong blue light. This changes bilirubin to water soluble products, which the baby can excrete in the urine.
If the bilirubin levels continue to rise and reach dangerous levels, a procedure known as exchange transfusion must be carried out. It involves the changing of the baby's blood with blood from a donor. This reduces the serum bilirubin levels to about a third of the level before the procedure. It is usually carried out in the sterile environment of an operation theater, and in expert hands, the risks are low.
Last revision: July 15, 2007
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