Our baby, fortunately, is now healthy, but she had severe jaundice at birth. Though the doctors looked for blood-group problems, they could not find the cause. She is thriving now and looks great, but do you think there could be complications later in life?
Jaundice in newborns is fairly common, affecting up to 60 percent of infants during the first week of life. The usual cause is that a baby has a high level of hemoglobin, the name for the red color in the blood. This hemoglobin has to be processed by the baby’s liver and excreted in the bile, but in most babies the liver metabolism is not switched on immediately. The hemoglobin is converted to bilirubin (the yellow pigment) and joined with an acid to make it soluble in the bile. It is important that this joining with the acid not take place before birth, because it would then not be able to cross the placenta. Before joining with the acid, the bilirubin is called unconjugated, because it is not processed, or conjugated, once joined with glucuronic acid. Babies with jaundice need to be carefully monitored, because high levels of bilirubin can damage an infant’s brain. Such outcomes, fortunately, are very rare these days, because doctors are aware of the dangers.
Some conditions further heighten the normal breakdown of red blood cells to bilirubin, and because an infant’s liver is immature they may cause a greater risk of jaundice. Among these is a blood-group incompatibility between mother and infant. One that is better known is where the mother is Rhesus negative and her baby or babies are Rh-positive.
The sequence of events is as follows: The baby’s blood cells cross the placenta into the mother’s circulation, and her immune system then makes antibodies that break down the “alien” red blood cells. These antibodies, unfortunately, can cross the placenta and attack the baby’s red blood cells inside the baby itself. It is usually a mother’s second or third baby that is more severely affected, because the repeated pregnancies act like “booster” stimulants to the mother’s immune system. Fortunately, today, an injection of antibody to the Rh antigen given to Rh-negative women prevents the more serious of these problems. The preparation is called Rhogam.
Other babies may be born with inherited disorders that cause their blood cells to break down more rapidly than normal, such as spherocytosis, or enzyme deficiency. Still other babies may have disorders of the liver, whereby the normal conjugation process is slowed down. A common one is called Gilbert’s syndrome.
The birthing process is difficult, and some babies are born with bruising under the scalp called a cephalo-hematoma, which is a collection of blood beneath the fibrous membrane covering the bones of the skull. As this blood is reabsorbed, it may deliver more hemoglobin than the liver can cope with.
The largest group of healthy babies that are jaundiced are those in whom breast milk is either inadequate in amount or contains large amounts of progesterone compounds, which further slow the liver’s maturity. These are transient effects and, if the jaundice level is not very high, of little consequence.
Phototherapy is a process whereby babies are exposed to intense light with, of course, little patches over their eyes. The light breaks the bilirubin, which can be excreted by the kidneys. The use of phototherapy has so greatly reduced the need for exchange transfusion that the once-common procedure is now rare.
Seeing your daughter has been discharged from the hospital, it can be assumed that she will have no further problems with effects of jaundice; although, should she have an underlying disorder, she could exhibit a tendency to anemia—but that would not be life-threatening. Follow up with your physician, and don’t worry; it sounds as though you have a healthy little girl.