Jaundice
A common condition in newborns, jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells.
Normally bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body.
Reasons for this include
A newborn baby's still-developing liver may not yet be able to remove adequate bilirubin from the blood.
More bilirubin is being made than the infant's liver can handle.
Too large an amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool.
High levels of bilirubin - usually above 20 mg - can cause deafness, cerebral palsy, or brain damage in some babies. In rare cases, jaundice may indicate the presence of hepatitis. The American Academy of Pediatrics recommends that all infants should be examined for jaundice within a few days after being born.
Types of Jaundice
There are several types of newborn jaundice.The following are the most common.
Physiological (normal) jaundice: Occurring in more than 50% of newborns, this jaundice is due to the immaturity of the baby's liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age.
Jaundice of prematurity: This occurs frequently in premature babies since they take longer to adjust to excreting bilirubin effectively.
Breast milk jaundice: In 1% to 2% of breastfed babies, jaundice can be caused by substances produced in their mother's breast milk that can cause the bilirubin level to rise above 20 mg. These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from 3 to 10 weeks.
Blood group incompatibility (Rh or ABO problems): If a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood. Incompatibility jaundice usually begins during the first day of life. Rh problems once caused the most severe form of jaundice, but now can be prevented with an injection of Rh immune globulin to the mother within 72 hours after delivery, which prevents her from forming antibodies that might endanger any subsequent babies.
Symptoms and Diagnosis
Jaundice usually appears around the second or third day of life. It begins at the head and progresses downward. A jaundiced baby's skin will appear yellow first on the face, followed by the chest and stomach, and finally, the legs. It can also cause the whites of an infant's eyes to appear yellow.
Since many babies are now released from the hospital at 1 or 2 days of life, parents should keep an eye on their infants to detect jaundice.
A simple test for jaundice is to gently press your fingertip on the tip of your child's nose or forehead. If the skin shows white (this test works for all races) there is no jaundice; if it shows a yellowish color, you should contact your child's doctor to see if significant jaundice is present.
At the doctor's office, a small sample of your infant's blood can be tested to measure the bilirubin level. The seriousness of the jaundice will vary based on your child's age and the presence of other medical conditions.
Treatments
In mild or moderate levels of jaundice, by 5 to 7 days of age the baby will take care of the excess bilirubin on its own. If high levels of jaundice do not clear up, phototherapy - treatment with a special light that helps rid the body of the bilirubin by altering it or making it easier for your baby's liver to get rid of it - may be prescribed.
More frequent feedings of breast milk or formula to help infants pass the bilirubin in their stools may also be recommended. In rare cases, a blood exchange may be required to give a baby fresh blood and remove the bilirubin.
If your baby develops jaundice that lasts more than a week, your doctor may ask you to temporarily stop breastfeeding. During this time, you can pump your breasts so you can keep producing breast milk and you can start nursing again once the condition has cleared.
If the amount of bilirubin is high, your baby may be readmitted to the hospital for treatment. Once the bilirubin level drops, however, it is unlikely it will increase again.
The cause of jaundice must be determined before treatment can be given. Prescribed therapy is to be followed to treat the underlying cause. Treatment of jaundice depends upon an individual case. In most cases, it is treated with antibiotics, a mild case usually resolves on its own. The disease leaves a lot of weakness in its wake and thus recuperation may take a long time. Generally, the best way to treat jaundice is to correct the underlying cause; the exact remedy depends on the nature and severity of the case.
- Drink 6-8 glasses of water a day
- Eat lots of raw fruits and vegetables (especially green leafy vegetables)
- Juice is good (make your own with a juice machine)
- Do not drink coffee, alcohol, soda pop, other junk food drinks
- Do not eat processed foods white sugar, white flour, etc.
- Use stress relief like going for walks in the park
- Brown rice and millet are good
- Avoid red meat and animal fats
- Reduce dairy products cheese, milk, and others
- Fast a few days a month
- A colon intestinal cleansing is helpful
- Get sleep
- Exercise light to moderate amounts eg. yoga and stretching are good
- Do not smoke and avoid second hand smoke
Most of the diseases discussed previously can affect women during pregnancy, but there are some additional causes of jaundice that are unique to pregnancy.
Cholestasis of pregnancy
Cholestasis of pregnancy is an uncommon condition that occurs in pregnant women during the third trimester. The cholestasis is often accompanied by itching but infrequently causes jaundice. The itching can be severe, but there is treatment (ursodeoxycholic acid or ursodiol). Pregnant women with cholestasis usually do well although they may be at greater risk for developing gallstones. More importantly, there appears to be an increased risk to the fetus for developmental abnormalities. Cholestasis of pregnancy is more common in certain groups, particularly in Scandinavia and Chile, and tends to occur with each additional pregnancy. There also is an association between cholestasis of pregnancy and cholestasis caused by oral estrogens, and it has been hypothesized that it is the increased estrogens during pregnancy that are responsible for the cholestasis of pregnancy.
Pre-eclampsia
Pre-eclampsia, previously called toxemia of pregnancy, is a disease that occurs during the second half of pregnancy and involves several systems within the body, including the liver. It may result in high blood pressure, fluid retention, and damage to the kidneys as well as anemia and reduced numbers of platelets due to destruction of red blood cells and platelets. It often causes problems for the fetus. Although the bilirubin level in the blood is elevated in pre-eclampsia, it usually is mildly elevated, and jaundice is uncommon. Treatment of pre-eclampsia usually involves delivery of the fetus as soon as possible if the fetus is mature.
Acute fatty liver of pregnancy
Acute fatty liver of pregnancy (AFLP) is a very serious complication of pregnancy of unclear cause that often is associated with pre-eclampsia. It occurs late in pregnancy and results in failure of the liver. It can almost always be reversed by immediate delivery of the fetus. There is an increased risk of infant death. Jaundice is common, but not always present in AFLP. Treatment usually involves delivery of the fetus as soon as possible.