Jaundice in premature babies

When you have a premature (premmie or preemie) baby, suddenly you find yourself in an unfamiliar hospital environment where staff talk about medical conditions you might know very little about.  Since having a daughter born 13 weeks early, I have learned a lot about the health issues faced by premature

babies, and have started writing short articles to explain some of these conditions.  You might find this article useful if you want to know more about your friend's premature baby or if you want to tell your friends and family about issues faced by your own premature baby.

Remember that each baby is different, and you should always consult a medical professional about circumstances which relate specifically to your child. 

Newborn Jaundice and your premmie / preemie

What is it?

Jaundice is a yellow discolouration of the skin and the whites of the eyes caused by hyperbilirubinemia (which means “increased levels of bilirubin in the blood”). Jaundice occurs in both full term and premature newborn babies, but is much more common in premature babies.

Why does it occur?

In the human body, new blood cells are being made all the time and old blood cells die. Soon after a baby is born, its body will start replacing foetal haemoglobin (the blood used by the developing foetus which enables oxygen to be transported via the umbilical tube) with adult haemoglobin (normal blood).  One of the products of blood as it breaks down is called bilirubin. Bilirubin is normally filtered by the liver and then leaves the body via a bowel movement.

Premature babies tend to develop jaundice because their livers are too immature to remove the bilirubin from their blood, so it builds up and spreads to other tissues in the body.  This is also known as physiologic jaundice. Bilirubin is a yellowish colour, which is why the baby’s skin takes on a yellowish tint.

Jaundice can also be made worse in a small number of babies by certain health problems such as having a different blood type from the mother.

Why is it a problem?

Jaundice is not usually a serious problem, although premature infants may be more sensitive to the ill effects of excess bilirubin.  Extremely high levels can be toxic, as bilirubin may enter the brain, causing hearing problems and brain damage.  However babies in hospital are carefully monitored and treated quickly before their bilirubin reaches dangerous levels.

How is it treated?

Doctors use a blood test to check the bilirubin level.

Moderate jaundice is treated by placing your baby naked or near-naked (with a protective mask over the eyes) under a special white or a bluish-coloured light. This is called phototherapy and can be delivered in many different ways safely, including via the use of special fibre-optic “bili-blankets”.  The light breaks down the bilirubin in the skin into a substance that the body can excrete more easily.  Usually phototherapy is needed for about a week, and after that, the liver is mature enough to excrete bilirubin on its own.

 In cases of severe jaundice where phototherapy is not effective, a baby may need to have a special blood transfusion in which their blood is replaced (exchanged) with donor blood to wash the bilirubin out of their system.

Are there any long term problems from jaundice?

There are usually no long-term problems following jaundice in babies. Babies who have had high levels of jaundice should have their hearing checked at regular intervals. This is best discussed with your doctor or early childhood nurse. Brain damage due to very high levels of jaundice is now extremely rare because the levels are carefully monitored while babies are in hospital.

---

I originally wrote this article for L'il Aussie Prems.  It is also published on my own website www.preminperth.net