Neonatal jaundice

Neonatal jaundice (hyperbilirubinemia) is a higher-than-normal level of bilirubin in the blood. Bilirubin, a by-product of the breakdown of hemoglobin (the oxygen-carrying substance in red blood cells), is produced when the body breaks down old red blood cells. Normally, the liver processes the bilirubin and excretes it in the stool. An excess of bilirubin in the blood leads to a yellow discoloration of the skin and the whites of the eyes called jaundice. This condition is particularly common in newborn infants. Before birth, an infant gets rid of bilirubin through the mother's blood and liver systems. Afterbirth, the baby's liver has to take over processing bilirubin on its own. Almost all newborns have higher than normal levels of bilirubin. In most cases,the baby's systems continue to develop and can soon process bilirubin. This development can be encouraged by beginning breastfeeding or formula feeding assoon as possible after delivery and continuing to feed the baby frequently.

Most cases of newborn jaundice resolve without medical treatment within two to three weeks. However, infants with very high bilirubin levels may need medical treatment to prevent serious complications, such as mental retardation, hearing loss, behavior disorders, cerebral palsy, or death.

One type of treatment is phototherapy--exposure of the baby's skin to fluorescent light. The bilirubin in the baby's skin absorbs the light and is changedto a substance that can be excreted in the urine. This treatment can be donein the hospital or at home with special lights which parents can rent for the treatment. Treatment may be needed for several days before bilirubin levelsin the blood return to normal. The baby's eyes are shielded to prevent the optic nerves from absorbing too much light. Another type of treatment uses a special fiber optic blanket. There is no need to shield the baby's eyes with this treatment, and it can be done at home. In rare cases, where bilirubin levels are extremely high, the baby may need to receive a blood transfusion.

All infants with jaundice should be evaluated by a health care provider to rule out more serious problems. Signs of severe hyperbilirubinemia include listlessness, high-pitched crying, apnea (periods of not breathing), arching of the back, and seizures.

Premature infants are especially likely to develop jaundice. The condition also is more common in some populations, such as Native American and Asian. Butin general, there is no way to predict which infants will be affected by hyperbilirubinemia.

Hyperbilirubinemia and jaundice can also be the result of other diseases or conditions. Hepatitis, cirrhosis of the liver, and mononucleosis are diseasesthat can affect the liver. Gallstones, a blocked bile duct, or the use of drugs or alcohol can also cause jaundice.

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