Health Tips

We've discussed regarding the causes, symptoms, risks, complications and ways to monitor jaundice in the previous post. Today, we'll be discussing on:

• effects of confinement food on jaundice
• hospital management of jaundice

Does confinement food worsen jaundice?

There is no confinement food that causes jaundice.

In Malaysia and Singapore, most mothers will go through a period called confinement which allows a mother to recuperate during the first month after delivery. In this period, certain herbs and food will be used more frequently.

Does ginger cause jaundice in a baby?

Now, there is no evidence at this point in time that suggests a direct correlation between ginger and jaundice. Maybe there is an association but not a direct cause. If you are breastfeeding and is taking in a ginger during this period and you notice that your baby’s jaundice has worsened, you need to look into other causes.

How about red dates?

Red dates used to make tea are rich in iron and vitamins. They have been widely used in mothers during confinement. There is no harm in taking them as long as you consume enough fluids to keep yourself hydrated. Dehydration leads to a reduction in breast milk, which may lead to breastfeeding jaundice.

And Benedictine D.O.M.?

Alcohol is also commonly used in some of the confinement dishes, especially D.O.M. It is relatively safe as the alcohol evaporates after being cooked. Alcohol in the cooked food itself does not cause jaundice. However, your baby may not be able to eliminate some of the alcohol that passes through breast milk as your baby’s liver is yet to mature. Your baby may end up being drowsy and not taking in the right amount of milk.

Remember to cover the eyes even if you are sunbathing your baby.

Sunlight for jaundice

This is somewhat controversial. If you know what you are doing, then it may be beneficial. Otherwise, it may worsen jaundice. Sunbathing a baby under the sun is not recommended these days as there is increased risk of sunburn and dehydration. However, if you feel strongly about sunbathing, do it safely with each session no longer than 15 minutes each session, 4 times a day. Remember to cover your baby’s eyes to avoid direct sunlight.

Breastfeeding is highly encouraged even if your baby is having jaundice.

Newborn jaundice treatment at home

The most important thing for you to do right now for your baby is to ensure that your baby is fed enough.

This is what you can do:

• Ensure that each feed is no longer than 3 hours apart.
• Breastfeed your baby at least 8 to 12 times a day.
• Ensure baby gets about 30 to 60 ml each feed.
• This helps your baby to remove the bilirubin through the stools and urine.
• Consider using infant formula intermittently if breastmilk supply is low.
• 4 to 6 wet diapers a day tells you that your baby is getting enough milk.
• A baby who opens his bowels (poo-poo) between 2 to 3 times a day is a good sign.

Neonatal jaundice chart (Malaysia)

Different countries have a different jaundice chart to follow. To make things simple, we’ll use the Malaysian one as a point of reference. Due to the complexity of the chart, you can skip this section if you want to. However, it’s good to know as it gives you an idea if what your baby needs.

A chart which shows whether a phototherapy or an exchange transfusion (ET) is a more appropriate treatment.

Just a quick explanation on how the jaundice chart works:

• Hours of life represents the hours from the time your child was delivered.
• Use the same unit on your baby’s blood result (mg/dL or μmol) for comparison.
• There are 3 risk groups: low/medium/high.
• The weeks’ portion represents the number of weeks mom has been pregnant.
• Pair it with risk factors below to determine your baby’s risk group.

Pair it with the number of weeks the mother had been pregnant with the child.

Once you have your baby’s risk group:

• Look at the correct risk column.
• Determine the number of hours after your newborn was delivered.
• Check if it hits the values stated in the column.
• If it hits the phototherapy’s value, your child needs phototherapy treatment.
• If it hits the ET’s value, the level is high enough to warrant an exchange transfusion.

Treatment of neonatal jaundice in hospital

If the level of jaundice gets too high, your child will require treament in the hospital. Always get a doctor involved in the care of your newborn’s jaundice. In the event that jaundice worsens, these are the treatment options:

Intravenous fluids

An intravenous line will be inserted into your newborn’s vein. It provides the necessary glucose and fluids for calories and hydration.

Phototherapy

Phototherapy is used to treat mild to moderate levels of jaundice.

• Your baby will be placed in a bassinet or an incubator under a special fluorescent lamp.
• The light will be absorbed by your baby’s skin.
• It turns bilirubin into another form which is excreted easily in the urine and stools.
• Each phototherapy session lasts about 3 to 4 hours.

Phototherapy does not damage your baby’s skin.

Surgery

What? A surgery to treat jaundice? Yes. In a rare condition called biliary atresia. There is an abnormality in a baby’s liver and a surgery is needed to correct it. Upon correction, the liver will function like normal to drain the excess bilirubin.

Blood exchange transfusion

In the case of severe jaundice, small amounts of blood will be removed from your baby.

• Blood will be replaced with a donor’s blood of the same exact blood type.
• A small tube inserted into your baby’s umbilicus.
• The level of jaundice will drop relatively fast.
• The entire process will take a few hours to complete.

That being said, blood exchange transfusion is not a first line treatment.

There are risks involved such as:

• bleeding
• blood allergies
• transmitted diseases

How to prevent neonatal jaundice?

To be honest, there is very little that you can do to prevent newborn jaundice. As we have mentioned earlier, most babies with jaundice are likely to be physiological. Getting a portable device like the above can be helpful but not very cost effective. Taking into consideration the time needed for a baby’s liver to mature, newborn jaundice is somewhat inevitable. However, the very least you can do for your little one is to ensure your newborn baby gets enough breast milk or infant formula. This will definitely help to minimise the risk of developing breastfeeding related jaundice.

Image credit:

1. https://img.medscape.com/news/2015/is_150402_phototherapy_infant_jaundice_800x600.jpg
2. https://www.happy-mummy.com/wp-content/uploads/Confinement-herbs-for-new-mom.jpg
3. https://www.istockphoto.com/my/photo/beautiful-latin-american-newborn-baby-in-incubator-getting-treated-for-jaundice-gm956193244-261076799
4. https://files.womenshealth.gov/files/styles/masthead/public/images/bf_mh_latching.jpg?od9ISwMRAeeVVF.u__l7m0X.J2eG27hW&itok=zoLUqy7l&c=716404969865a0aba113d0b0c0efff39
5. https://lh3.googleusercontent.com/c6Bl_qvREIlCpZJcHQIK6R_iXncBWi6-1Y1zg70TmMIHvpmBwH4eO9LW79LA4CKBToMm=s160
6. https://lh3.googleusercontent.com/Yhe_FXSNSP0ycA1qsNyVkr5olJQSlVDk3MKd3o4x4GbdQYK04lJbT5JFy-vi5E8PWa90=s160

References:

1. Management of Neonatal Jaundice | Clinical Practice Guidelines by Ministry of Health Malaysia
2. Newborn Jaundice | MedlinePlus
3. Neonatal Jaundice | Medscape
4. Jaundice (Newborn) | NUH kids
5. Treating jaundice in newborn babies | NHS choices

In collaboration with Ethissa

Written by

Dr. Eric Siew