Roughly 60 percent of all newborns have some degree of jaundice. This number is deceptive, however, perhaps leading us to believe that neonatal jaundice is nothing of concern. But the danger is very real.
Bilirubin Levels and Jaundice in Newborns
Babies with jaundice have a yellow discoloration of the skin due to a high level of bilirubin in the blood. Bilirubin is a pigment that is released when red blood cells are broken down. Under normal conditions, the liver removes bilirubin from the body, but in some newborn infants, the liver is not mature enough to do this efficiently.
If the yellow coloring of a baby’s skin and in the whites of the eyes goes unrecognized and the jaundice is not treated, a condition called kernicterus can develop. Kernicterus is a type of brain damage caused by high levels of bilirubin in the blood, and can lead to hearing loss, vision problems, intellectual disabilities, and cerebral palsy. To prevent kernicterus and its associated complications, early detection and treatment of jaundice in newborns is critical.
Errors in Diagnosing Infant Jaundice
Recently, NBC News that diagnostic errors are more common than we imagine. Postmortem examinations indicate that in 10 percent of cases, a wrong diagnosis contributed to the patient’s death. Of all the adverse events occurring in America’s hospitals – including untreated jaundice leading to birth injuries and possible medical malpractice lawsuits – up to 17 percent are due to diagnostic errors.
Twenty-one-year-old Cal Sheridan of Boise, Idaho, is an example highlighted in the NBC News report. His mother took the newborn to several doctors and hospitals when she noticed he was yellow, lethargic, and feeding poorly. Doctors and nurses repeatedly told her that this was normal and that as a first-time mom she was worrying too much. In 1995, the year Cal was born, testing a newborn baby’s bilirubin level was not routine. Cal developed kernicterus, but a neurologist still did not see the danger. At that point, the baby was arching his back, trembling and wailing inconsolably. By the time Cal received treatment, it was too late. Today, he has severe cerebral palsy with speech and hearing impairment and walks with a walker. Cal will continue to need care for the rest of his life.
Paying Attention to Signs of Jaundice
Despite the potentially catastrophic consequences, infant jaundice is easy to diagnose and treat. The Centers for Disease Control suggests parents stay vigilant for yellow or orange-hued skin, which typically develops in the head area and spreads towards the toes. An overly sleepy baby or a baby who does not sleep at all is also a warning sign. Parents of fussy babies who do not breastfeed or bottle-feed well and babies with very few wet diapers should seek medical attention. Signs and symptoms that require emergency care include a high-pitched cry, inconsolable crying, arching of the body, a floppy body, a stiff body, and strange eye movements.
It is easy to test a baby’s bilirubin level with a light meter. If this level is high, a blood test can confirm the exact bilirubin level. Doctors consider a level above 20 to be dangerous. Bilirubin levels are highest in the first five days of life and should be checked every 8-12 hours the first two days and again when the baby is five days old.
Brain damage from untreated jaundice and kernicterus is easily preventable with phototherapy, a noninvasive treatment in which the baby is placed under special lights. For babies with a very high level of bilirubin, an exchange transfusion of blood may be necessary.
Preterm babies, babies with dark skin, babies of Asian or Mediterranean descent, babies with siblings suffering from jaundice, babies with a tendency to bruise, and babies born to mothers with blood type O or Rh-negative are at particularly high risk of developing infant jaundice.
Talk to your pediatrician about your baby’s jaundice bilirubin test results. Keep your baby well fed as this helps keep the bilirubin level down. If you are concerned that your baby may have jaundice, don’t wait, act quickly!