American Medical Association Family Medical Guide - American Medical Association [163]
An extremely rare but more serious form of neonatal jaundice, called obstructive jaundice, is caused by malformed or absent bile ducts in an infant’s liver. In this disorder, bile (a digestive fluid produced by the liver) and bilirubin cannot pass out of the liver, and bilirubin builds up in the blood, causing jaundice. Other rare causes of neonatal jaundice include neonatal hepatitis (see page 786), hypothyroidism (see page 404), and some rare blood disorders.
Neonatal Intensive Care Unit
If your baby is born before the 37th week of pregnancy (preterm), weighs less than 5 pounds, or has a serious infection, respiratory problem, or birth defect, he or she may be taken immediately to the neonatal intensive care unit (ICU) of the hospital, or transferred to another hospital that has a neonatal ICU. Immediate care improves the baby’s chances for survival and long-term health. Babies born after the 26th week generally do well. Although their development may be delayed, most preterm babies catch up to full-term babies by 2 years of age.
In the neonatal ICU, babies are kept warm in incubators and attached to electronic monitors that check their vital signs. Oxygen may be supplied if a baby’s lungs are underdeveloped. Blood samples are taken regularly from a catheter (a thin, flexible tube) placed in the infant’s umbilical cord, arm, or leg to make sure the kidneys and liver are functioning properly and the infant is not receiving too much oxygen.
At first, babies are fed breast milk or formula through a tube inserted into their stomach through their nose, or they are fed nutrients intravenously (through a vein). Later, they are fed with a bottle. Your baby will be able to breastfeed as soon as he or she gains strength and his or her sucking reflex improves. In the meantime, express milk from your breasts regularly to provide breast milk for your baby while in the neonatal ICU and to keep your breasts producing milk for when you can breastfeed. Freeze any extra milk for later. A lactation nurse will give you instructions on how to freeze breast milk. Breast milk is especially beneficial for preterm infants because it provides essential nutrients that promote development and antibodies that help fight infection. If breastfeeding is not possible, formulas are available that provide the nutrients and extra calories that preterm babies need for growth.
Babies usually stay in the neonatal ICU until their weight reaches 4 to 5 pounds and any life-threatening conditions have been treated successfully.
Neonatal intensive care
Inside the incubator, tubes provide essential life support, and sensors help to monitor your baby’s condition. Although you cannot hold, cuddle, or breastfeed your baby, spend as much time as you are allowed touching, stroking, and talking to him or her. This stimulation can dramatically improve your baby’s breathing and physical development and helps you bond with your baby.
All types of jaundice carry a slight risk that the increased level of bilirubin in the blood will cause brain damage. However, brain damage almost never occurs when a baby is treated and the level of bilirubin in the blood is closely monitored.
Symptoms
In all types of neonatal jaundice, a baby’s skin and whites of the eyes turn yellow. The yellowing usually occurs within the first day after birth in hemolytic jaundice, after about 3 to 5 days in physiologic jaundice, and after 1 to 2 weeks in obstructive jaundice. In physiologic jaundice and mild hemolytic jaundice, the yellowing is slight and usually disappears