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Aug 04

Jaundiced, When Baby’s Eyes Are Yellow

While working at one of the inner city hospitals in New York City, I had the burden of telling a mother that her new-born will not go home as planned because the baby’s skin is too yellow-jaundiced and that the baby needed to be treated with light {phototherapy}.

My assessment brought tears on the mother’s eyes. ‘This is not a cause to cry for’, I said, ‘your baby will be okay’. I went on to tell her about the baby’s condition and what I intended to do about it.

There is a long list of what can cause jaundice in the newborn. This article addresses only the most common cause, which is the problem of high level of unconjugated bilirubin in the blood of the new-born baby. The problems posed by a high level of conjugated bilirubin in the blood do exist, but these will not be discussed in this article.

What is jaundice?

Jaundice is a term used to describe yellowness of the skin, eyes or other parts of the body. It can occur in both the young and the old. For the purpose of this article, yellowness of the skin and jaundice has the same meaning and are used interchangeably.

Where does bilirubin come from?

Bilirubin is the name of the pigment that gives the body the yellow stain. It comes from broken or hemolyzed red blood cells. The form of bilirubin responsible for most of the jaundice seen in the newborn is known as the unconjugated bilirubin. The baby’s liver is supposed to get rid of bilirubin. When their levels are high, they stain the body. When the level of bilirubin is dangerously high, they can injure the developing brain.

How do I know if my baby has jaundice?

Every new-born baby has some bilirubin in their blood. When a baby is visibly yellow, it indicates that it has a higher than expected level of bilirubin in their blood.

Newborn babies are looked over and examined multiple times a day by doctors and health care providers for jaundice. Eye examination is highly subjective. Two experienced health care providers may differ on whether a baby is jaundiced or not based solely on eye observation. It is harder to tell when a black -skinned baby is jaundiced, when compared to a light- skinned baby. Experienced parents, or relatives—those who had babies with jaundice may suspect abnormal yellowness of the skin.

Laboratory confirmation is frequently needed. One of the ways is to collect blood from the baby’s heel. The blood is then taken to the laboratory for analysis of the degree of jaundice.

What causes jaundice in babies?

Two reasons account for most of the jaundice seen in the newborn:

– There are more than expected red blood cells breakdown or hemolysis and release of bilirubin

– The baby’s liver enzymes responsible for facilitating the excretion of bilirubin in the stool and in the urine are not fully functional or are not entirely activated.

Physiological jaundice

Gentle rise of bilirubin during the first three days of life, followed by a gradual fall within five days of life is expected in many newborns. This normal trend of rise and fall in bilirubin level is called physiological jaundice. Bilirubin levels in physiological jaundice can go from around 2 mg/dl to about 6mg/dl. By the time a baby is 5-7 days old, the level falls back to around 2mg/dl or below. No treatment is needed for most physiological jaundice.

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