Learning About Jaundice
Nina Mitchell
Bainbridge Island, Washington, USA
From: NEW BEGINNINGS, Vol. 10 No. 1, January-February 1993, pp. 12-13
We provide articles from our publications from previous years
for reference for our Leaders and members. Readers are cautioned to
remember that research and medical information change over time.
During the first and second
day of my son's life we cuddled and nursed freely in our bed. On the
third day my son moved into a plastic bassinet with bilirubin lights
for a roof and clear plastic for walls. He lived in there for three
days; my husband and I could take him out only every two hours to monitor
his temperature, change his diaper, and nurse him on a schedule.
Normal physiologic newborn
jaundice was our doctor's diagnosis; he ordered phototherapy and water
supplements.
Jaundice is a common, usually
normal, yellowing of a newborn's skin and the whites of his eyes. Usually
jaundice disappears without treatment, but health professionals agree
that frequent breastfeeding and skin exposure to daylight can both prevent
and treat jaundice.
If needed, medical tests
can determine the type and degree of jaundice; most newborn jaundice
is normal physiologic jaundice. The degree of any type of jaundice is
measured in milligrams of bilirubin per deciliter of blood. Bilirubin
is an orange-yellow pigment and it is a byproduct of the breakdown of
red blood cells.
In short, babies with normal
physiologic jaundice turn yellow because they cannot process and excrete
bilirubin as fast as they break down the extra red blood cells that
they no longer need once they are born and taking in plenty of oxygen
on their own.
In contrast to normal physiologic
jaundice (which usually disappears without treatment) abnormal pathologic
jaundice often requires medical treatment to slow a rapidly rising bilirubin
level. High levels of bilirubin are of greatest concern with premature
or sick babies.
My husband and I had not
noticed our son's jaundice. It was our midwife who noticed a yellowish
cast to his skin on a routine thirty-six hour home visit. She suggested
that we take him to see a doctor the next day.
Early the next morning the
doctor walked with us out into the bright Arizona sunshine so that he
could get a good look at the baby's color. He poked his skin gently
and told us that our baby did look jaundiced.
The doctor asked us exactly
when Francis had turned yellow. Physiologic jaundice usually appears
on the second to fourth day in normal full-term babies. In contrast,
abnormal or pathologic jaundice is often visible at birth or within
the first twenty-four hours.
We could not tell the doctor
exactly when Francis had turned yellow, because we had not looked for
or noticed the yellowing. So, the doctor ordered blood tests to rule
out pathological jaundice.
At a nearby lab, the technicians
took Francis' blood for testing. I had asked Dr. Cabin to avoid puncturing
Francis' veins and to only take blood from a heel stick if possible.
After the technicians assured us that they were experienced with newborns,
they pinned Francis down to a table to prick his heels with the tiny
tubes that draw blood through capillary action and store it.
Francis screamed; it was
an urgent pain howl that I had never heard before. Tears poured from
my unbelieving eyes and I ached to hold or at least touch him. This
precious baby, caught by my husband, nurtured at my breast, lovingly
examined by our midwife and our doctor was now being repeatedly jabbed
in the heels by strangers.
They could not get enough
blood for the bilirubin test by heel sticks, although this method usually
works. Finally, these two lab workers talked about drawing blood from
Francis' veins instead of his heels and they asked why the doctor ordered
no vena puncture. When I told them that order started with my request,
they implied that I had caused the heel stick fiasco. I consented to
the vena puncture and finally after puncturing both arms, they got some
blood. We left.
My husband and I were anxious
to get home and recapture some of our shattered peace. In retrospect,
we should have gone to the medical library instead; the next day our
ignorance about jaundice cost us again.
When the doctor called with
the test results we were relieved to hear that Francis' jaundice was
almost certainly normal jaundice. We were relieved for only a moment;
then the doctor said he wanted more blood tests to see if Francis' bilirubin
level was falling from the 16.1 mg/dl that the lab had measured. My
husband and I did not want to go back to the lab for more blood taking.
In desperation we asked for home phototherapy lights; we thought treatment
with lights would end the need for testing. Our doctor was wonderful
and if we had talked with him more we probably could have avoided both
the lab and the bilirubin lights. He had told us at the outset of our
consultations that he wanted to avoid bilirubin lights, if possible.
Unfortunately we did not discuss all options with the doctor. So, although
we avoided the lab, Francis still needed heel sticks twice a day and
three days of phototherapy.
Phototherapy, even though
it was at home, was difficult for our family. I missed the easy bliss
of sleeping with my baby. Instead I slept next to this plastic bassinet
in the glare of the bilirubin lights. I missed sleeping and waking on
our own schedule. Instead I was awakened every two hours on the phototherapy
schedule.
Every two hours my husband
or I took Francis out of his chamber, took his temperature, and I breastfed
him. We would take off the patches that protected his eyes and hold
him close. Francis breastfed well from the first few minutes after his
birth. We avoided nipple confusion by breastfeeding exclusively with
no pacifiers or bottles. From our midwife we learned that frequent and
exclusive breastfeeding helps prevent jaundice. When we told our doctor
about this research he approved skipping the water supplements that
he had initially recommended.
My husband and I did not
even think to follow Francis' natural wake-sleep patterns. We were too
scared and too ignorant to modify the instructions that our doctor and
home health care people gave us. The arbitrary schedule quickly exhausted
me. It seemed as though every time I began to dream, it was time for
the two-hour break.
Somehow I muddled through
those days and we even learned how to get a good heel prick: I held
Francis upright against my chest, my husband warmed Francis' entire
foot and leg with a warm wet diaper, the nurse pricked his heel. Francis
always cried out briefly--a simple cry of pain and surprise--and the
tube filled with blood in just a few seconds.
Francis' bilirubin level
peaked at 17mg/dl and we continued to monitor and treat him with phototherapy
until it retreated to about 14 mg/dl. That took about three days so
Francis was nearly a week old when our doctor gave orders to stop phototherapy
and testing.
We now know that many experts
believe a normal full-term baby can safely experience bilirubin levels
of 20-25 mg/dl before intervention is warranted.
A recent review article
on jaundice (Newman and Maisels 1990) indicates there was essentially
no evidence of adverse effects on IQ, neurological assessment, or hearing
in term infants who had been jaundiced. (This conclusion was based on
studies that included more than 30,000 infants.)
In an article in the November
1990 issue of BREASTFEEDING ABSTRACTS, Kathi Kemper, MD, MPH, suggests
that prolonged hospitalization, phototherapy, and the interruption of
breastfeeding may be unnecessary and even harmful for the mother and
for the infant with normal neonatal jaundice. She writes, "In the case
of healthy term infants who are jaundiced, the treatment could be worse
than the disease."
My husband and I came to
that same conclusion ourselves. Before our daughter, Delsa, was born
we had researched jaundice. We had also established a good relationship
with our doctor. After Delsa was born we worked to prevent jaundice
with frequent breastfeeding and plentiful skin exposure to daylight.
Delsa still turned yellow
with jaundice, but we knew enough to communicate daily with our doctor
who had also attended Delsa's birth. We told her exactly when, on Delsa's
second day, Delsa began to yellow; we told her what parts of Delsa were
yellow (first her head and then her torso); and we reported on Delsa's
general condition (she was often alert and breastfed vigorously).
We were concerned about
the jaundice, but we were convinced that frequent breastfeeding and
exposure to daylight were the best things for Delsa. We talked to her
doctor every day until after the yellowing diminished. This took more
than a week, but it was a peaceful week, compared to the first week
of my son's life.
Frequent breastfeeding,
lots of information, and a good doctor-parent relationship helped Delsa
through physiological jaundice. That should surprise no one, because
physiological jaundice is normal, it is not a disease.
References
Kemper, Kathi. Neonatal
jaundice in the development of the vulnerable child syndrome. BREASTFEEDING
ABSTRACTS 1990; 10(3)7.
Newman, T., B. and M. J.
Maisels. Does hyperbilirubinemia damage the brain of healthy full term
infants? Clin Perinatol 1990; 17(2):331-58.
Last updated Wednesday, October 11, 2006 by njb.
Page last edited Sun Oct 14 09:30:33 UTC 2007.
