Jaundice is probably one of the first medical terms new parents learn.
Around 60% of full term and 80% of premature newborns develop jaundice in the first month after birth.
Jaundice isn’t a disease or infection. Newborn jaundice is caused by a buildup of bilirubin – the yellow substance produced when the body breaks down old red blood cells.
In utero, the placenta is responsible for this process. After birth, the baby’s liver takes over.
However, in newborns with elevated bilirubin, the liver hasn’t quite matured enough to take on this task quickly, which results in a build up of bilirubin. You can read more about jaundice here.
Jaundice In Newborns – Is It Harmful Or Protective?
In very rare instances, jaundice is a serious condition. In the vast majority of cases, however, it seems to be a normal part of the transition from womb to world.
If jaundice is a natural process, with a small risk of complications, there must be a reason why 60-80% of human beings experience it after birth.
Newborn Jaundice Could Be Protective
You gave birth a day or so ago. You’re ready to leave hospital, or maybe you’re preparing for a checkup following your homebirth. Someone notices your baby’s skin is a bit yellow, and he is sent for a distressing heel prick.
This is how so many new parents are thrown into learning about paediatric healthcare and navigating medical decisions for their new baby.
If you’re anything like me, you might be wondering, “Wait a minute. This happens to 60% of people? What’s wrong with the human body? Why would so many babies’ livers not function in time to prevent this?”
Well, new research shows it might not be a human body error, but rather a case of people taking the wrong approach to understanding and managing jaundice.
Richard Hansen and other researchers from the University of Aberdeen began to wonder about this after Hansen had been looking after a septic newborn in the NICU. The newborn’s bilirubin levels were quite high; typically, this level is only seen when a baby has an immune response to his mother’s blood type.
Hansen began to wonder whether there could be a direct link between the high jaundice levels and the baby’s infection. Sepsis is a serious immune response to an infection and it can lead to inflammation, organ damage and death.
The researchers’ results were promising, and his theory jaundice could have a protective role in sepsis was backed by evidence.
The results have been published recently in the journal Nature, and the research showed a direct link between infection and bilirubin:
“Our team have shown that even modest concentrations of bilirubin reduced by one third the growth of Gram-positive Streptococcus agalactiae. We also showed that bilirubin may alter substrate metabolism in the bacteria”.
Perhaps we’ve been overly cautious, and we’ve been fighting a natural protective transition from womb to world.
Should We Treat Newborn Jaundice?
The researchers said, “When newborn babies develop jaundice in future, we’ll still need to treat it carefully. But quite possibly we will also be thankful that it’s protecting them from something potentially life-threatening”.
When my oldest son was born, we experienced an uncomplicated, unmedicated, out of hospital birth. About six days later, his jaundice looked to be severe. After a heel prick, he was admitted for 24 hours of light and IV therapy.
This happened eleven years ago, and the rise in exclusive breastfeeding in some areas was still at its lower end. Concerns about his intake were quickly eliminated when it was determined he had already surpassed his birth weight. After 24 hours, we were released, still exclusively breastfeeding.
A week later, he developed a serious viral infection – respiratory syncytial virus (RSV) – which was most likely acquired as a result of being in and out of medical settings. During his observational stay for RSV, it was found his jaundice levels had once again risen. There was a bit of panic, lots of treatment, and talk of serious complications.
When I later relayed this information to a group of IBCLC certified lactation consultants, I was told, “Well of course his jaundice went up; he had an infection”.
Over time, more information about breastfeeding, jaundice, and how to manage it came to light and we had much better experiences with our subsequent children.
This new research supports the reason my son’s body had an increase in jaundice, despite having received prior phototherapy. It seems the body’s systems know how to protect a fragile neonate.
Of course, this recent research didn’t look at this specific virus, but it supports the idea the human body provides its own natural protection.
Although research supports the idea jaundice is a part of the normal transition from womb to world, it doesn’t support never monitoring or treating jaundice.
The study suggests, however, we continue to research when it should be treated, and what levels are actually of concern.
“This will enable us to think about whether clinicians should raise the accepted bilirubin threshold for babies at risk of sepsis – those born prematurely, for example”, said the researchers.
Newer research might show the numbers aren’t of as great a concern as specific behaviours (e.g. lethargy, feeding difficulties, etc.). One baby could have very elevated levels and be quite fine, while another might have moderate levels and need treatment.
It might also show, if a newborn has an infection, it might be beneficial to let the levels remain somewhat elevated.
This research is a very important step forward, towards a better understanding of jaundice, but it hasn’t quite given a clear answer on how medical providers should manage it.
Perhaps it shows us, however, we need to trust the human body a bit more and to look at each baby as unique. If babies are healthy, and feeding well, then perhaps we needn’t turn their first few days into a medical event, because of a bit of yellowing in the skin.
We hope more research will give us the answers.
Be sure to read Bilirubin Levels – What’s Normal And What’s Not to learn more about the various types of jaundice and what different levels mean.