American Medical Association Family Medical Guide - American Medical Association [164]
Diagnosis
To diagnose jaundice, a doctor checks a child’s skin and the whites of the eyes for yellowing. If either looks yellow, the doctor will order blood tests to measure the levels of bilirubin, red blood cells, and liver enzymes in the child’s blood. In some cases, a doctor will recommend an ultrasound scan (see page 111) or X-rays to examine the child’s liver and bile ducts. In addition, a doctor may order blood tests to check for possible underlying causes of jaundice, such as Rh incompatibility.
Treatment
Most cases of physiologic jaundice clear up on their own without treatment. Mild cases of hemolytic jaundice also usually disappear without treatment. Feeding the infant stimulates the passage of meconium (the first bowel movement of a newborn) and the transition to normal stool. Bilirubin is excreted in the stool, which helps lower the levels of bilirubin in the blood.
Treating neonatal jaundice
If your baby needs phototherapy for jaundice, you may be able to give the treatment at home. A visiting nurse can teach you how to use the phototherapy equipment and will monitor your baby during daily visits to your home. For the treatment, ultraviolet light is delivered through a fiberoptic panel fitted into a cotton flannel sleeve that wraps around the baby like a wide belt. You can hold, feed, and change your baby while the belt is on. The longer the belt is worn each day, the faster the child’s bilirubin reaches a safe level. The process usually takes 3 to 4 days.
For obstructive jaundice, surgery to correct the blockage in the outflow of bile and bilirubin from the liver must be performed to prevent fatal liver damage, which can occur within a few months without treatment. In some cases, when the blood level of bilirubin is high, a doctor may perform phototherapy (light therapy), in which the baby is exposed to ultraviolet light to help convert the bilirubin into a form that will pass easily out of the liver, into the urine, and out of the body. Severe cases of jaundice, especially hemolytic jaundice, are treated by an exchange blood transfusion, in which all the baby’s blood is replaced with donated blood.
Feeding Problems
Many babies cry for a few minutes after breastfeeding or bottle feeding. If your baby cries after feeding, cuddle and comfort him or her; if your baby has had enough to eat, he or she will soon stop crying and fall asleep. If your baby continues to cry, or cries a lot between feedings, he or she may not be getting enough breast milk or formula. Try giving your baby more but do not force him or her. Babies stop eating when they have had enough. Some babies cry because they are thirsty, especially in hot weather. Try giving your baby some water. If your baby begins to fuss soon after starting a bottle, he or she may be frustrated because the nipple hole is too small or clogged. If this occurs, substitute another nipple.
Poor Feeding
In the first few weeks of life, some babies fall asleep while feeding. Babies this age generally eat small amounts but need to eat frequently throughout the day and night (sometimes as often as every 2 or 3 hours). This is normal. In a healthy baby, this phase usually passes after about a month. Offer the baby the breast or bottle when he or she wakes up or when he or she cries, but don’t force the baby to feed if he or she turns away. If this pattern of feeding continues or if the baby seems lethargic or seems to be losing weight, see your pediatrician. Your child’s doctor will determine if your baby is getting enough milk or formula by checking his or her weight and growth pattern.
You also should contact your doctor if your baby feeds slowly or does not seem to be eating as much as usual.
Spitting Up or Vomiting After Feeding
Most babies spit up a little milk or formula after feeding, particularly when they burp. Bottle-fed babies are more likely to spit up because they are