Jaundice in newborns is a common problem encountered in the clinic. Common questions include “Does jaundice matter, do I need sunlight, do I need glucose water, do I need to stop breastfeeding? 1. What is jaundice? When a baby’s skin or sclera looks yellow, it means that he or she has jaundice, which is an increased level of bilirubin in the blood. The body’s red blood cells have a life span (120 days on average), and the dead red blood cells are metabolized by the body to produce (indirect) bilirubin, which is fat-soluble and toxic to the nervous system when it exceeds a certain level, to the liver to be metabolized into direct bilirubin (non-toxic), which is excreted through the biliary-intestinal tract (a source of yellow or green stool). 2, newborn infants why jaundice in the first days of life About half of full-term infants and 80% of premature infants will have jaundice, most appear the day after birth, peaking at 3-5 days and disappearing in about 1 week. Premature infants can continue to have jaundice for up to 2 weeks and it is called physiologic jaundice. Causes include Newborn babies have more red blood cells and a shorter life span (90-100 days on average). The liver is immature and metabolizes bilirubin at a slower rate. Many of the bilirubin excreted into the intestine is reabsorbed. 3.Bilirubin toxicity Bilirubin is a normal metabolic product of the body, and low levels of bilirubin are not harmful to infants. High levels of bilirubin toxicity is mainly for the brain, full-term infants have a relatively complete brain barrier function, bilirubin is not easy to invade the brain. However, above a certain range, generally 20-25 mg/dl (340-428 umol/L) or more there is a risk of cerebral palsy, blindness and hearing loss (kernicterus). Sometimes, the presence of significant jaundice or persistent jaundice in infants may indicate some kind of disease in the organism, such as infection, hemolysis, thyroid dysfunction, etc. 4. What conditions indicate jaundice that may indicate the presence of disease: Jaundice appears too early, within less than 24 hours. Rising too fast: more than 5 mg/dl (85 umol/L) per day. Jaundice level is too high: usually physiologically no more than 12 mg/dl (205 umol/L). Duration too long: more than 1 week without remission. Elevated direct bilirubin: elevated direct bilirubin indicates liver disease. 5. What types of jaundice are there Physiologic jaundice, as previously described. Immune hemolytic jaundice: ABO hemolysis, mainly seen in mother’s blood type O, father’s other blood type, may cause when the baby is A alive B; Rh hemolysis, mother Rh-, father Rh+. Breastfeeding jaundice, mostly occurs within one week after birth, caused by insufficient breastfeeding, not caused by breast milk itself (eating too little). Breastfeeding jaundice: mostly occurs 2-4 weeks after birth and reappears after the jaundice has subsided and persists. Sometimes it lasts longer. It is caused by certain components of breast milk that promote increased bilirubin reabsorption in the intestine. Internal bleeding: cephalohematoma is the most common. Other causes such as more red blood cells in the body, poor thyroid function, infection, etc. 6, treatment Generally milder jaundice does not require treatment. It is most important to observe the development of jaundice. Be sure to have your doctor check the level of jaundice initially, and observe at home if no treatment is needed for the time being. Generally jaundice starts on the head and face and gradually spreads to the whole body, so the face is the most yellow. If jaundice develops to the trunk, abdomen or even the extremities with jaundice, bring the baby to the hospital again to check the actual level, which has a large visual error. Usually the earlier the jaundice appears, the weaker the baby’s ability to tolerate it and the greater the likelihood that it will develop into higher levels of bilirubin, so jaundice that appears at 24 hours or progresses quickly requires hospitalization and a search for the cause. The main treatment is phototherapy. Currently, phototherapy is more effective, has fewer side effects and is mostly temporary. Hospitalization is usually required. In severe jaundice, if phototherapy fails, blood exchange is required to avoid neurological damage. Does more sunlight help? Sunlight is generally weak, exposes few body parts, and the duration of exposure is unlikely to be long, so sunlight cannot have a significant effect. Sunlight contains ultraviolet rays. Therefore, more sunlight is not recommended, but proper sunlight is beneficial. What are the available medications? There are drugs that inhibit bilirubin production, such as sn-mesoporphyrin, but they are not widely used clinically at this time. Some other drugs lack clinical basis. Drinking glucose water? There is no clinical evidence that this is effective. Do I need to stop breastfeeding? In the case of breast milk jaundice, breast milk can be stopped in severe cases of jaundice, but pumping maintains breast milk production and can be fed again when the jaundice has decreased. In mild cases, it is not necessary to stop breastfeeding because the jaundice is not harmful. Chinese medicine? There is a lack of clinical basis, and there is a lack of empirical analysis of the toxicity of Chinese medicine to newborns. 7. In which cases it is necessary to take the baby to the doctor immediately Jaundice appears within 24 hours after birth or deepens very rapidly. Infant has fever. Poor milk intake. Depression. Other abnormalities. 8. What is nuclear jaundice Nuclear jaundice, also known as bilirubin encephalopathy, occurs when jaundice levels are very high, or if the infant has a disease that causes damage to the barrier function of the brain. It has become relatively rare with the early start of phototherapy and good results. The main manifestations are fever, hypertonia, corns, convulsions and other neurological symptoms. Therefore, if there are no neurological symptoms, there is no need to worry about the development of kernicterus, but it may not be easily observed in infants born prematurely or with poor response to severe disease. Nuclear jaundice, if it has occurred, is irreversible damage, so at higher bilirubin, blood exchange is needed if phototherapy fails, and at very high bilirubin blood exchange is needed promptly to avoid nuclear jaundice.