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 Even if your newborn wasn't jaundiced, watch how yesterdays' state-of-the-art becomes today's out-of-date pediatric care.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 Even if your newborn wasn't jaundiced, watch how yesterdays' state-of-the-art becomes today's out-of-date pediatric care.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
8 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
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