Praying for Poop: When Your Newborn has Jaundice

My newborn was born a month ago. As many of you know, the first seven days of her life were full of trips to the hospital to have her bilirubin blood levels checked. By her fifth day of life, her bilirubin levels peaked at dangerously high levels and she was sent to the hospital for phototherapy to lay “under the lights” for 24 hours. Although my husband and I knew that jaundice is very common among newborns, it didn’t help alleviate our anxiety over the fact that our baby’s tiny body was struggling and there was nothing more we could do to help her. We both took turns sitting next to her in the hospital, praying for poop.

That’s right, poop. (Suddenly I’m having flashbacks to Triumph, the Insult Comic Dog).

Why poop, you ask?

Jaundice, or a yellowing of the baby’s skin and eyes, is caused by excess bilirubin in the baby’s blood. Bilirubin is produced by a normal breakdown of red blood cells. Jaundice occurs when bilirubin builds up faster than a newborn’s liver can break down the bilirubin and pass it, via poop, from the baby’s body. Newborns make more bilirubin than adults and many newborn’s livers, not yet fully developed, may not be able to remove enough bilirubin from the blood.

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 another condition, such as an infection or a thyroid problem. The American Academy of Pediatrics (AAP) recommends that all infants should be examined for jaundice within a few days of birth. An estimated 60% of newborns have jaundice, many of which will not require additional treatment.

What to Expect if Your Infant has Jaundice
1. Heel pricks.
This is how they extract blood from newborns to check their bilirubin level. Most labs will put a foot warmer on your baby’s foot before they prick their heel. If your lab does not do this, I would find a lab that does. My second daughter had to have her bilirubin levels checked and it took the lab technician 25 excruciating minutes, while she screamed, to push enough blood out of her heel to fill a small vial for testing – because her heel was cold. If their heel is properly warmed, the blood will drip out (instead of being squeezed out) and should only take a couple of minutes.

2. Different ‘acceptable’ bilirubin levels based on your newborn’s age.
The older your newborn is, the higher the acceptable level of bilirubin. Of course, there is a ceiling. Most newborns’ bilirubin peaks when they are 5-7 days old, and then it begins to decrease. Generally, when a newborn’s bilirubin level gets close to 20, most doctors will require that they get phototherapy treatment immediately – but ultimately your pediatrician will determine what level is safe for your newborn.

3. If you’re a breastfeeding mom, you might be required to introduce a bottle early
I have nursed two babies before my third and have always been blessed with a massive supply. No matter how amazing your supply is, if you have a jaundice baby, the doctors will probably suggest that you supplement baby with breastmilk in bottles. My pediatrician recommended that we offer our daughter a bottle after every feeding with an additional 1 oz of breastmilk. She wanted to make sure that we gave our newborn the opportunity to “fill up” after every meal, since the only way newborns can eradicate jaundice from their bodies is to poop it out. I didn’t hesitate to follow doctors orders, despite my concern that she might reject my breast by introducing the bottle when she was only a few days old. Well, doing this had no effect on breastfeeding. She is over a month old now, and I typically nurse during the day and offer her bottles of breastmilk during the night (makes it easier on me since my husband can give her a bottle and I can get a few hours of uninterrupted sleep).

4. Several types of treatment options, home phototherapy and/or hospital phototherapy
Hospital Phototherapy while in Recovery & Postpartum
Our newborn’s bilirubin levels were elevated before we were released from the hospital. Because of this, our pediatrician recommended that our daughter be placed on the lights. Since her levels weren’t high enough to warrant triple phototherapy (which we’ll get into later), she was placed on lights. The photo on the left is what this phototherapy option looks like. The lights are below the baby, and they are allowed to have a blanket on top of them, exposing their back, bottom, and back of their legs to the lights.

Home Phototherapy
The last day we were in the hospital, our daughter’s pediatrician prescribed a home phototherapy kit. The hospital nurses called an outside agency, and within a couple of hours a representative from a phototherapy company came to the hospital and trained my husband and me how to use the unit. She was to stay attached to the unit 24×7 for several days – while eating, sleeping, even while having her diaper changed. The light was a small piece of plastic, about 4 inches by 6 inches, that was to be placed on our daughter’s back. A long cord came out from below the plastic, that had to be plugged into an electrical outlet.

Every day, we were required to return to the hospital’s lab to have her heel pricked and her bilirubin level checked. By the time she was 5 days old, her bilirubin level was so high that our pediatrician told us that she needed to go back to the hospital for hospital phototherapy.

Hospital Double or Triple Phototherapy
While the lights at the hospital are much stronger than the home phototherapy unit, insurance usually dictates what bilirubin level are “high enough” to warrant hospital double/triple phototherapy.

For hospital double/triple phototherapy, the newborn is placed in an incubator-looking device, and the lights are underneath and above the newborn. Although it is quite warm under the lights, the newborn is not allowed to wear anything other than a diaper and a pair of glasses designed to protect their eyes. It is very uncomfortable for most newborns, as they usually prefer to be swaddled. In the incubator, their arms and legs flail about and they constantly struggle to get comfortable. Our newborn also swatted at her glasses on her eyes, which required either her dad or I to be sitting next to her 24×7 so that we could adjust her glasses every few minutes to protect her eyes.

While in the hospital, your newborn’s blood will get drawn every 6 hours. When the baby’s biirubin levels drop below levels that the hospital doctors will deem safe, the baby will be sent home.

5. A rebound bilirubin check
Once your newborn is released from the hospital, they will have to have their heel pricked at least once more. The doctors call this the “rebound check.” Basically, if the newborn’s bilirubin returns to dangerous levels 6-12 hours after leaving the hospital, they will likely require additional phototherapy. The hospital staff assured us that high rebounding bilirubin levels were rare. When we had our daughter’s bilirubin levels checked 12 hours after she was released from the hospital, they had decreased slightly from when she was released from the hospital. This indicated that her body had responded well to the phototherapy and would continue to eradicate the bilirubin over time, through her poop.

And today, thankfully, she is jaundice-free.

-Have your children had jaundice?
-What treatment options did your child undergo to eradicate the jaundice?

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