[Sportschosun reporter Jang Jong-ho] Many parents worry when they see their baby's skin or the whites of the eyes turn yellow after birth. Neonatal jaundice is a common condition in newborns and usually improves on its own, but in some cases it can signal a disease that requires treatment. Severe jaundice can also lead to neurological damage, so it is important to closely monitor when it appears, how long it lasts, and the baby's overall condition.
◇Six out of 10 newborns experience jaundice
Neonatal jaundice refers to the yellowing of the skin and eyes caused by an increase in bilirubin in the blood. Bilirubin is produced when old red blood cells break down, and it is metabolized in the liver before being excreted in stool. However, newborns have shorter red blood cell lifespans than adults, which leads to greater bilirubin production, and their liver function is still immature right after birth, so they cannot eliminate it sufficiently. As a result, bilirubin in the blood may temporarily rise and cause jaundice.
The most common type is physiologic jaundice. It occurs in about 60% of healthy newborns. It usually begins to increase on days 2 to 3 after birth, peaks around days 4 to 5, and then improves naturally without special treatment.
◇Jaundice can also appear during breastfeeding
Breast milk jaundice is divided into early and late types depending on the cause. Early breast milk jaundice occurs when the baby does not get enough breast milk, while late breast milk jaundice can appear even in babies who breastfeed well because of components in breast milk.
Early breast milk jaundice develops within the first week after birth and is often caused by insufficient feeding. Therefore, it is important to feed frequently and adequately, about 8 to 12 times a day, while checking weight gain and urine output. In most cases, it improves within one to two weeks.
Late breast milk jaundice, on the other hand, appears after the first week of life. In healthy newborns, one of the known mechanisms is that beta-glucuronidase in breast milk increases the reabsorption of bilirubin in the intestine. It usually becomes most severe around 2 to 3 weeks after birth and then gradually disappears over a period ranging from 2 weeks to as long as 2 to 3 months. If breastfeeding is temporarily stopped, the jaundice may improve, but this does not mean breastfeeding should be permanently discontinued. In most cases, breastfeeding can continue, and the decision should be made after consulting medical staff, taking into account bilirubin levels and the baby's condition.
◇How can normal jaundice be distinguished from dangerous jaundice?
Not all jaundice is normal. Pathologic jaundice should be suspected if jaundice appears within 24 hours after birth, if bilirubin levels rise rapidly by more than 5 mg/dL per day, or if jaundice lasts longer than 10 to 14 days.
Causes of pathologic jaundice include hemolytic disease due to blood type incompatibility, congenital infection, biliary atresia, galactosemia, and hypothyroidism. The risk is also higher in premature infants, low-birth-weight babies, and those with cephalohematoma.
One of the questions parents ask most often is whether jaundice can be checked at home. Although bilirubin levels cannot be measured accurately at home, the extent of jaundice can be roughly estimated by observing how far the yellowing of the skin has spread.
Jaundice usually starts around the face and eyes, then spreads to the chest, abdomen, and limbs, and finally to the palms and soles. If jaundice is limited to the face, bilirubin is estimated at about 5 mg/dL. If it reaches the abdomen, it is about 12 mg/dL, and if it extends to the palms and soles, it is estimated at around 20 mg/dL.
However, these are only reference points and do not indicate exact values. Jaundice can be assessed with a transcutaneous bilirubin meter or a blood test, and blood testing is the most accurate method. If jaundice appears severe or it is difficult to judge the baby's condition, it is best to visit a medical institution for testing.
◇The baby's condition matters more than skin color
If jaundice worsens, bilirubin in the blood can deposit in brain cells and cause kernicterus. Kernicterus is a complication that causes fatal neurological damage to the brain. It is rare, occurring in about 1 in 100,000 people.
If the baby seems more lethargic than usual, feeds poorly, becomes less active, or shows reduced normal reflexes, medical attention should be sought immediately. If kernicterus develops, the risk of death may increase, and even survivors may be left with long-term complications such as cerebral palsy or hearing loss.
◇Jaundice treatment: phototherapy and exchange transfusion
The standard treatment for neonatal jaundice is phototherapy. Blue light at a specific wavelength, about 460 to 490 nm, is applied to the skin to change the structure of bilirubin in the body, allowing it to be excreted more easily in bile and urine without passing through the liver. It is a noninvasive and relatively safe treatment that is widely used.
If bilirubin levels continue to rise despite phototherapy, or if the risk of kernicterus is high, exchange transfusion may be performed. Exchange transfusion is a treatment in which a small amount of the baby's blood is repeatedly removed through a catheter and replaced with clean blood. This not only lowers bilirubin in the blood, but in hemolytic diseases such as blood type incompatibility, it also removes antibodies that destroy red blood cells and damaged red blood cells, allowing levels to drop quickly. It is used only in severe cases that do not respond to phototherapy, and because it is an invasive procedure with a risk of complications, treatment is usually carried out in the neonatal intensive care unit.
Lee Seong-hee, a professor in the Department of Pediatrics and Adolescent Medicine at Ilsan Hospital of the National Health Insurance Service, said, "Neonatal jaundice usually improves naturally, but depending on when it appears, how long it lasts, and how severe it is, there may be an underlying condition that requires treatment." She added, "If jaundice appears within 24 hours after birth, progresses rapidly, lasts a long time, or if a baby with jaundice is not feeding well and seems lethargic, medical evaluation is essential."
Reporter Jang Jong-ho bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
