Treating jaundice

How will a baby with jaundice be handled?

Jaundice in infants is largely as a result of bilirubin production and under-developed liver function. Once this stabilises, jaundice typically resolves itself. A baby will still be monitored while displaying signs of jaundice though.

Moderate to severe cases of jaundice in infants may be treated with phototherapy (‘bili lights’). A baby will only be allowed to have on a nappy (diaper) and protective eye patches, and will be laid down on a light-emitting mattress or pad. A side-effect of this therapy may be that your baby will experience more frequent bowel movements (this is a good thing) and his or her stools may appear green in colour.

If a mismatch in blood type between a new mother and her baby is determined, the baby may also be given an intravenous immunoglobulin (IVIg) transfusion. The blood protein given will reduce the level of antibodies passed on from the mother and help alleviate the effects of jaundice.

It can happen, although rarely, that severe jaundice is unresponsive to the aforementioned treatments and an exchange transfusion of blood may be necessary.

Small amounts of blood will be drawn repeatedly. Each will be diluted with bilirubin and a mother’s antibodies before being transferred back into the new-born.

How will jaundice in an adult be handled?

Jaundice in adults is typically regarded as a symptom and not necessarily treated directly. The illness causing jaundice, however, will undergo a treatment plan. Once the underlying cause of jaundice is treated, it typically resolves itself and the discolouration experienced will return to normal.

Depending on the nature of the underlying cause, treatment may be managed at home, and in some instances, hospitalisation may be required.

Common treatments for underlying causes may include:

• Home care: Underlying causes which may be mild can be managed without the need for hospitalisation, but may require consultation follow-ups to monitor a person’s condition.
• Substance discontinuation / alcohol cessation: Where substances such as excessive alcohol are causing cirrhosis of the liver, acute pancreatitis or alcoholic hepatitis, treatment will include discontinued consumption in order for the body to begin healing. Medication use (intentional and unintentional overdose) will also need to be discontinued to alleviate aggravated symptoms, such as jaundice.
• Medications and antibiotics: A doctor will carefully prescribe medications that will help to promote healing and clear up symptoms. These can include steroids for the treatment of autoimmune disorders, or diuretics and lactulose for those suffering cirrhosis complications. Bacterial infections will be treated with a course of antibiotics, killing off the cause and helping to promote healing in the body.
• Blood transfusions: In some instances, the underlying cause could be anaemia from haemolysis (RBCs breakdown before their typical lifespan ends). Blood transfusions can help to replenish the body with RBCs and promote normal function.
• Specialist treatment: Where a serious disease is the underlying cause, a person may be referred to an appropriate specialist. For instance, a cancer patient will be referred to an oncologist for treatment which will need to be carefully determined depending on the type and stage of the disease.
• Surgery: Where necessary, the underlying cause may require invasive procedures in order to repair or correct an underlying problem. Liver failure or cirrhosis may require a liver transplant to restore the patient to health. Sometimes the underlying cause may be gallstones or a blocked bile duct which need surgical interventions to correct.

Home care – what can a mother do for her baby?

Where a new-born has a mild case of jaundice, you will be allowed to take your baby home. Your paediatrician will discuss any necessary adjustments in your feeding schedule beforehand so as to lower the levels of bilirubin in your baby’s system.

It can happen that in the days after being discharged from hospital, your healthy baby develops jaundice. Your paediatrician may diagnose ‘breast-feeding jaundice’ or ‘breast milk jaundice’ during your consultation discussion and assessment. It could merely mean that a substance in your breast milk is blocking proteins in the liver, and your baby’s system is unable to metabolise bilirubin or that your baby isn’t getting enough milk. If it is determined that your baby is latching well and getting enough milk, a blood test may still be recommended to make the diagnosis as to what is causing jaundice.

You may begin to worry when advised to stray from your planned feeding schedule, but you need not panic. Your paediatrician will guide you and address all your concerns so that you are completely comfortable with how much and how often your baby will need to be fed. Jaundice can make a little one a bit fussy or difficult to feed. Your paediatrician will guide you.

You will not be discouraged from breastfeeding (or formula feeds). Your paediatrician may advise:

• More frequent feeds: With the increased levels of bilirubin in your baby’s system, you will need to encourage more frequent bowel movements. To do this, your paediatrician may advise more frequent feeds. More frequent bowel movements mean your baby will be excreting more of the chemical compound, alleviating symptoms of jaundice. If you are breastfeeding, your paediatrician will recommend 8 to 12 feeds a day during your baby’s first week or so of life. If you are opting to feed your baby formula, you will be encouraged to feed your baby every 2 to 3 hours.
• Breastfeeding supplements: It is common for a jaundiced baby to have trouble being breastfed. A baby can easily become dehydrated and lose weight as well. In these instances, supplemental feeds will be encouraged. You can either try giving your baby formula or expressed breast milk. You may need to feed your baby formula for a few days before returning to breastfeeding.