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Was your baby jaundiced? Are you worried? Good news!
Dr. P's Journal Club
As you loyal readers know, one of my goals with this blog is to help you to be informed consumers of medical literature and pediatric advice. Admittedly, it can be confusing and a daunting task for those of you with little training or appreciation of the scientific method, but it's worth the effort.
Here's another example of how new scientific evidence changes practice. Even if your newborn wasn't jaundiced, watch how yesterdays' state-of-the-art becomes today's out-of-date pediatric care.
Here's another example of how new scientific evidence changes practice. Even if your newborn wasn't jaundiced, watch how yesterdays' state-of-the-art becomes today's out-of-date pediatric care.
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When I was just starting out in my pediatric training, I was taught to obsessively follow bilirubin levels in healthy, full-term newborns because "levels over 20 could cause brain damage."
As a result, we would occasionally perform "exchange transfusions" on healthy, full-term babies (taking out the baby's jaundiced blood and re-infusing blood from a donor, in order to keep the levels below 20). I well remember many an exhausting all-nighter, extracting via a large IV an infant's blood and reinfusing new blood. Out goes the bad blood, in goes the good blood, over and over again. This laborious task took hours, side effects were not rare, and I was a bleary-eyed basket case the next day.
As it turns out, there wasn't a lot of evidence to support this practice but, as often happens, "better safe than sorry" sometimes prevailed and it was pretty much considered the state-of-the-art. (But not everyone. In 1983 a famous and wonderful pediatrician named Frank Oski coined the term "vigintiphobia," meaning "fear of the number 20", to poke fun at what he concluded - correctly, as it turned out - to be an unwarranted phobia.)
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The study:
- 140 healthy but jaundiced, full-term infants born in 1995-1998 were followed over time.
- 130 had bilirubin levels between 25-20, and 10 had levels greater than 30.
- They were compared to infants born at the same hospital without jaundice (a valid study almost always has a "control" group, i.e., a healthy comparison group).
What the study found:
- None suffered brain damage ("kernicterus").
- Follow-up neuro-developmental testing two years later or more showed no significant differences between the jaundiced and the control group.
- Parents did not report greater behavioral problems or concerns in their formerly jaundiced toddlers.
- This information does not imply that jaundice can never cause long term developmental trouble in healthy, full-term newborns, just that the levels most babies experience (less than 30) don't appear to.
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Dr P Comments
I wanted to familiarize you with this study to:
- Show how pediatric practice changes in the face of new data.
- For those of you whose pediatric providers have not kept up with the latest evidence and still suffer from vitiginophobia and who, as a result, needlessly scared the bejesus out of you in the process.
- For you parents who have never shaken that fear and still wonder if their child's newborn jaundice could lead (as has caused) some developmental or behavioral problems in your child.
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Two caveats from Dr. P:
- Remember, this evidence applies to full-term healthy infants. Premies and seriously ill newborns are another story.
- It will be important to follow these kids as they get older to be sure nothing subtle shows up later on (for example at school age).
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Study cited: "Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more." Newman T., et al. New England Journal of Medicine. May 4, 2006.
Related Topics: Newborn Growth & Development: Common Concerns, Understanding Newborn Jaundice
Technorati Tags: newborn, jaundice, bilirubin
16 Comments:
How can I control my biluribin level?
my baby is one month old and she was born with jaudiced and she always have inword fewer can this be because the jaundiced?
My first baby was born 12 days early with jaundice twenty-seven years ago and is now in grad school going for his doctorate...so I would say it didn't affect him in any serious way!
Dr. Parker and Other Posters,
Personally, I'm in disagreement with your view on jaundiced and other doctors (peds or OB/GYNs or Family Practioners) because you rather do it the way you were taught instead of doing it the way it has been done before you came along.
Both my children developed jaundice in the hospital due to the fact (I believe) that my body does not produce enough colostrum, and therefore they weren't getting enough fluids to flush their system. (Once my milk came in, the yellow cleared up within 24 hours). Neither one got to the "magic number 20" but were yellow enough to make me worry :) Luckily both pediatricians (different one for each child) were calm and didn't try to scare us. I appreciated that.
Natural Skin Care Site
My daughter is 9 months old and she looks real yellow. I don't notice it, I guess because I'm with her everyday. Should I be worried? She had jaundice when she was born, but could it be that at this age?
My son is 11 days old. At 36 hours old his bilirubin level was @ 11.6. At 4 days old it was @ 20.3 He recieved phototherapy until he was @ a 14. Then he was released from the hospital. Then 2 days later for a follow up his level went back up to an 18! He recieved a bili blanket for home use, and now we are awaiting the latest bilirubin results. He is still VERY yellow. He is breast fed, but he eats all of the time and has plenty of bowel movements and urine! He sleeps a lot, but he is alert at times. He is not sluggish, just seems to sleep like a normal newborn. What do you think.
My son was born 2 weeks early and was severly jaundiced we were sent home the health nurse came and he was worse we were sent to the hospital and he was placed into the intensive care unit for 5 long days under 5 lights it was so scary.... his level finally came down and we were sent home now a year later they are still doing test but he may be deaf in his left ear from this but he is still with us even with a critical level
I don't know much about yellow jaundice in infants. I was wondering if a infant has a severe case of this, can it fatal?
So happy to see that some and in fact most do not have complications from jaundice, however if vigilant doctors dave the lives of a few then the sleepless nights of residents as they do exchanges is worth it! For us, by the time they did the first exchange it was to late - our daughter life was changed. As a result of a doctor that said " all kids have jaundice and it is no big deal - and one that felt it was "just breast milk jaundice - no biggie", my daughter has suffered. As a result of her jaundice at birth she now hasRAD tracheal, bronchial mylacia, chronic aspiration
Cyst in the right parotid gland, Osteopenia
Ogilives Syndrome, pseudo bowel obstruction, reverse peristosis of the small intestine,TPN dependent with 10 different IV medications, Chronic constipation, Neurogenic bladder
Seizure Disorder, Severe Dystonia with tremors
Autonomic Nervous System Disorder - resulting in
irregular blood pressures, cold extremities at
times, tachycardia-bradycardia
Immune Defincy - Extremely low B-cells, low T-cells, MRSA respiratory and Group G Strep positive
Developmentally newborn.
She is 16 and requires 24 hour care... so parents should be aware of the risk and doctors should never say never!
wwwcaringbridge.org/ky/january
Kernicterus (brain damage from high bili count) is alive and well contrary to the doctors' laissez-faire attitude. I appreciate the babies you did save during your 'old fashioned methods'. I have twins who were treated on day 8 for counts of 21 and 20. It peaks well before that, I sadly found out. One twin is perfect. The other twin has all the symptoms of Kernicterus. She cannot hold her head up at 22 months old, or roll over let alone sit alone. She now has cerebral palsy. They were only 1 month early, weighing around 5 lbs each. Very healthy! We don't know yet if she has Auditory Neuropathy but she does have enamel damage to her teeth. Her beautiful smile and great sense of humor is locked in a body that cannot move or express itself the way she wants and needs to.
All of us Kernicterus parents who live with the hell of seeing our child who was born perfect and healthy, who now lives in pain and anguish would have relished a medical staff that was obsessed with jaundice!
To those who are concerned about your child's jaundice....follow your gut and keep an eye on the levels and press your medical team to be careful. Otherwise, you may be joining our very sad group. Look for them arching backward...this is a sign of brain damage occuring. And yes, children do die of this. From the complications that it creates. Please look at the www.pickonline.org website for more information and support.
As a caveat, I know a family who has a son who's count was much higher than my children and he appears to be fine although his vocabulary is not where it should be (possible hearing loss?).
The thing about Kernicterus is that they don't know who it will hit hard. Every child is effected differently. Bilirubin lights are completely safe and so simple. Blood transfusions have risks and certainly shouldn't be taken lightly but obviously necessary when needed.
I also disagree. I realize that bili levels above 20 CAN (although it doesn't always) leave a child unharmed. More importantly, I have learned first hand the importance of taking jaundice seriously. When my son left the hospital with a bili of 14, they down played it, when we took him to the pediatrician twice with yellow eyes, he downplayed it and treated it like a common cold.
My son had a large bruise on his head, and although he was a healthy full term infant that fed well and surpassed his birth weight within 3 days, at 9 days of life, he began to exhibit signs of Kernicterus. We took him to the ER and that 14 had turned into a bili of 45.6. He now has SEVERE Cerebral Palsy, Hearing Loss, Dental Enamel Hypoplasia, and is fed round the clock via feeding pump. He's a very smart little boy trapped in a body that just doesnt' work. If only someone had emphasied the importance of asking the pediatrician for a blood test and/or a bili blanket! A few simple things could have saved my precious boy from a lifetime of unimaginable hardship. (His life care plan is 41 million) Kernicterus is scary, but it is also 100% preventable...no need to fear...just to treat newborn jaundice appropriately.
Fortunately for most of you, you will never have to deal with the day to day issues of a child with Kernicterus. I think that a healthy fear, or appreciation of what can happen should be supported. My son's pedi thought it could never happen as well. Now my son has to live with a mind that is complete and a body that does not cooperate. For real information please visit www.pickonline.org
To all new parents, Kernicterus is real. Two of my three children have KI. (Brain injury from jaundice) please do not believe anyone who tries to down play the effects of jaundice. It is serious and it is happening everyday.
It’s time we as parents take a stand and try to educate ourselves about the damaging effects of Jaundice. Demand that you want your Childs bilirubin levels checked and your child given phototherapy if the levels are above 12(or even rising slowly) want to see what can happen to your child if their jaundice is not treated? Visit: www.amakashope.org.
This is very real. It happened to me, has happened to hundreds and as you read this, it will probably happen to one more child.
My son was healthy, sent home from the hospital with jaundice, but we needed to go to the doctor the next day to check it. They sent him for blood work and admitted him to the hospital where he spent 5 days under the lights for 24/7. He appeared to be fine and do everthing when he was supposed to, However he entered Kindergarten last year and we noticed some sort of LD. He is now in 1st grade and we believe it is some sort of Perception processing disorder. More testing will be done but he struggles. Does this study or is there a study that shows effects in school age children. I have 4 children, My son is the only one who was jaundice and he is the only one with an LD. I know that can happen, it just makes me question it.
My child was born 2 weeks early and was in the hosp for 6 days. His highest number was 32. He is now in 1st grade and has alot of trouble in reading and spelling. Our doctor would always tell me our child would have some trouble in school. I dont know what to do to help him at this point.
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