Patient's question:
Baby was found to have jaundice on the second day of birth, and blood tests showed a level of 340. After three days of hospital treatment, the jaundice level decreased. However, in the past two days, the jaundice index has been fluctuating. It dropped to 220 the day before yesterday, but rose to 250 yesterday morning. After treatment, it decreased to 202 yesterday, but today morning it rose again to over 260. Is it normal for the baby's condition to fluctuate like this? How low does the jaundice index need to be to be considered cured? How many more days should be observed after treatment before discharge? Will it still fluctuate after discharge?Doctor's answer:
How to Identify Neonatal Jaundice? Carefully observing the changes in the baby's jaundice is very important for distinguishing between physiological jaundice and pathological jaundice for treatment. Parents can identify it based on the following characteristics:Physiological jaundice in newborns is generally not severe, with the following features:
① Jaundice usually appears 2-3 days after birth.
② Jaundice gradually deepens, reaching its peak on the 4th to 6th day, then gradually subsides.
③ Full-term newborns typically see jaundice disappear within 2 weeks after birth, while premature infants usually take about 3 weeks.
④ The jaundice is usually mild, with the skin appearing pale yellow. Jaundice often affects only the face and upper body. The baby is generally in good condition with normal temperature, appetite, urine and stool color, and normal growth and development.
⑤ Blood bilirubin levels exceed normal by 2 mg/dL but are less than 12 mg/dL. If the baby's jaundice fits this description, parents do not need to worry.
Pathological jaundice has the following characteristics:
① Jaundice appears too early, within 24 hours after birth.
② Jaundice persists for too long, lasting beyond the normal duration, or returns after initially subsiding, or worsens progressively after reaching its peak.
③ The jaundice is severe, often affecting the entire body, with yellowing of the skin and mucous membranes.
④ Blood bilirubin levels exceed 12 mg/dL or rise too quickly, with a daily increase of more than 5 mg/dL.
⑤ Besides jaundice, other abnormal conditions are present, such as fatigue, reduced crying or movement, decreased appetite, or unstable body temperature.
Severe pathological jaundice can lead to bilirubin encephalopathy, commonly known as "kernicterus," causing neurological damage, severe long-term consequences like intellectual disability, and even death. Therefore, if any of the above five signs are present when a baby has jaundice, parents should pay close attention to detect pathological jaundice early for timely treatment.
Caring for a Jaundiced Baby
When a newborn shows jaundice, parents should pay attention to the following:
(1) Assess the severity of jaundice. Under natural light, observe the extent of skin yellowing. Mild jaundice is limited to the face; moderate jaundice affects the torso; severe jaundice involves the limbs and soles of the feet.
(2) Monitor stool color. If the stool is clay-colored, pathological jaundice should be considered, often caused by congenital biliary malformations. If jaundice is severe, accompanied by symptoms or abnormal stool color, seek medical attention promptly to avoid delaying treatment.
(3) Ensure the meconium is expelled as soon as possible. Meconium contains a lot of bilirubin, and if not fully eliminated, it can be reabsorbed into the bloodstream, worsening jaundice.
(4) Provide the newborn with adequate fluids, as infrequent urination hinders bilirubin excretion.
Medical Advice:
Most newborns may develop skin yellowing within the first week of birth, a condition known as neonatal jaundice, due to bilirubin deposition on the skin. This occurs because newborns have excessive red blood cells with a short lifespan, leading to excessive bilirubin production. Additionally, immature liver function limits bilirubin metabolism, contributing to jaundice.
Neonatal jaundice can be either physiological or pathological. Physiological jaundice does not require special treatment and resolves on its own. Pathological jaundice is caused by diseases that disrupt bilirubin metabolism and occurs during a specific period in newborns, often worsening physiological jaundice and making it difficult to distinguish. Pathological jaundice is divided into infectious and non-infectious types. Infectious jaundice is caused by bacterial or other pathogen infections, such as viruses, syphilis, or toxoplasmosis. Non-infectious jaundice includes hemolytic jaundice, biliary atresia, and genetic diseases.
In addition to physiological and pathological jaundice, there is also breast milk jaundice. Its characteristics include:
- Jaundice is more severe than physiological jaundice.
- The duration of jaundice is longer, sometimes lasting up to three months.
- The baby is generally in good health with no other identifiable causes of jaundice.
- After stopping breastfeeding for three days, jaundice levels drop significantly.
Breast milk jaundice is related to the reabsorption of bilirubin in the intestines and generally does not cause bilirubin encephalopathy. However, it is important to note:
To diagnose breast milk jaundice, pathological jaundice must be ruled out first.