Memorial Makes Jaundice Testing on All Newborns
a "Standing Order"
December 2003 — Jaundice affects 60 percent of all newborns. The majority of babies recover easily, most without treatment. For a small percentage, however, jaundice left untreated can result in severe brain damage.
A simple blood test can help protect these babies. The problem is, since the test is not legally mandated, most hospitals don't require it.
Memorial Regional Hospital, Joe DiMaggio Children's Hospital and Memorial Hospital West are among a select few hospitals in South Florida that have made testing for jaundice part of their routine newborn care. This is especially important for at-risk newborns, including babies born prematurely, who bruised at birth or who have a sibling who had jaundice.
Screening for Risk
"The term jaundice refers to the yellow coloring of a baby's skin that results from a substance called bilirubin," says Richard Auerbach, MD, Chief of the Neonatal Intensive Care Unit (NICU) at Joe DiMaggio Children's Hospital and neonatologist on the medical staff at Joe DiMaggio Children's Hospital and Memorial Hospital West. "Bilirubin is made during the normal process of old red blood cell breakdown. During the first few days of life, before a newborn's liver is mature enough to excrete bilirubin from its body, a build-up can occur. A significant build-up above normal levels can be toxic to the brain, causing seizures and brain damage — a condition called kernicterus."
A simple blood screening shows the level of bilirubin present in the baby's blood and helps to determine the risk of kernicterus. "Testing for jaundice at 48 hours allows us to predict with approximately 95 precent accuracy who will have future problems," says Dr. Auerbach. "It is performed at the same time as state-mandated tests, so it doesn't even require an additional blood draw."
Symptoms of Jaundice
The symptoms of jaundice typically include the yellow coloring of the baby's skin, usually beginning on the face and moving down the body. Gently pressing on the baby's forehead or chest and watching the color return can help identify this. Poor feeding or lethargy are also signals that jaundice may be present.
Jaundice may result from prematurity, bruising of the baby during labor or birth, blood incompatibility, sepsis or exposure to certain drugs given to the mother in labor. "In most cases, jaundice is harmless," says Dr. Auerbach. "The goal is to keep the level of bilirubin from increasing to dangerous levels."
Treating Jaundice
Babies with jaundice are typically treated with a safe and effective procedure known as phototherapy. During phototherapy, the baby is placed under a special set of lights that helps the body speed up the breakdown of bilurubin. Fiber optic blankets may also be used to treat jaundice, either alone or in combination with regular phototherapy.
In other cases, an exchange transfusion may be necessary, which involves replacing the baby's damaged blood with fresh blood. By alternately giving and withdrawing blood in small amounts through a vein or artery, an exchange transfusion helps lower the levels of bilirubin.
"Promptly detecting severe jaundice allows newborns to get therapy in time to prevent serious brain damage," says Dr. Auerbach. "That's why we chose to incorporate jaundice testing on newborns at 48 hours into our standing orders at Joe DiMaggio Children's Hospital and Memorial Hospital West."