A friend told me her baby has jaundice and it sounds like baby S has it worse than normal. For some reason almost every baby born in Singapore seems to have mild jaundice. I wonder whether its just pediatricians here being extra cautious and ordering phototheraphy regardless of whether there is a real need for it. This friend said she has been told to try stopping breastfeeding and switching to formula milk. I was surprised to hear that breastmilk can actually be harmful to baby in some instances and this prompted some research on jaundice.

First up, what is jaundice? Or more precisely, what causes jaundice. Most of us have some vague knowledge that jaundice is where one’s skin looks yellow. When I was a kid my mum was perpetually asking my doctor why are my palms so yellow (rather than pinkish) but I think in that case the yellow palms were caused by low blood count from thalassaemia minor rather than jaundice. Apologies for digressing, back to what is jaundice.  Jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells.

Normally, bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than a newborn’s liver can break it down and pass it from the body. Reasons for this include:

  • Newborns make more bilirubin than adults do since they have more turnover of red blood cells.
  • A newborn baby’s still-developing liver may not yet be able to remove adequate bilirubin from the blood.
  • Too large an amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool.

High levels of bilirubin — usually above 25 mg — can cause deafness, cerebral palsy, or other forms of brain damage in some babies. In less common cases, jaundice may indicate the presence of another condition, such as an infection or a thyroid problem.

Scary eh? I used to think Singapore pediatricians are just being “kiasu” when they order phototheraphy and toyed with the idea of just carrying my baby out into the sun more often to combat jaundice. Now I think I better let the experts do whatever is best. Wouldn’t want to end up causing brain damage!

Other than an under-developed liver, jaundice can also be caused by insufficient breast milk or, in rare cases, a certain substance in breastmilk. So my friend was right, there could be a chance the jaundice is caused by breastfeeding. How terrible.

The last kind of jaundice I learnt about was caused by blood group incompatibility (Rh or ABO problems). If a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant’s red blood cells. This creates a sudden buildup of bilirubin in the baby’s blood. Incompatibility jaundice can begin as early as the first day of life. Rh problems once caused the most severe form of jaundice, but now can be prevented with an injection of Rh immune globulin to the mother within 72 hours after delivery, which prevents her from forming antibodies that might endanger any subsequent babies.

After learning all of that, its still not very clear to me why exposing the baby to phototheraphy will cure jaundice. There’s something about the light altering the bilrubin such that its easier for the baby’s liver to get rid of it. I wonder whether the light is indeed UV light, as widely believed, or something else.

One thing for parents to note: when babies are undergoing phototherapy, ensure his/her eyes are well covered and that he/she gets plenty of fluids.


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