Jaundice in premature babies

What is it?

Jaundice is a yellow discolouration of the skin and the whites of the eyes caused by hyperbilirubinemia (which means “increased levels of bilirubin in the blood”). Jaundice occurs in both full term and premature newborn babies, but is much more common in premature babies.

Why does it occur?

In the human body, new blood cells are being made all the time and old blood cells die. Soon after a baby is born, its body will start replacing foetal haemoglobin (the blood used by the developing foetus which enables oxygen to be transported via the umbilical tube) with adult haemoglobin (normal blood). One of the products of blood as it breaks down is called bilirubin. Bilirubin is normally filtered by the liver and then leaves the body via a bowel movement.

Premature babies tend to develop jaundice because their livers are too immature to remove the bilirubin from their blood, so it builds up and spreads to other tissues in the body. This is also known as physiologic jaundice. Bilirubin is a yellowish colour, which is why the baby’s skin takes on a yellowish tint.

Jaundice can also be made worse in a small number of babies by certain health problems such as having a different blood type from the mother.

Why is it a problem?

Jaundice is not usually a serious problem, although premature infants may be more sensitive to the ill
effects of excess bilirubin. Extremely high levels can be toxic, as bilirubin may enter the brain, causing hearing problems and brain damage. However babies in hospital are carefully monitored and treated quickly before their bilirubin reaches dangerous levels.

How is it treated?

Doctors use a blood test to check the bilirubin level.

Moderate jaundice is treated by placing your baby naked or near-naked (with a protective mask over the eyes) under a special white or a bluish-coloured light. This is called phototherapy and can be delivered in many different ways safely, including via the use of special fibre-optic “bili-blankets”. The light breaks down the bilirubin in the skin into a substance that the body can excrete more easily. Usually phototherapy is needed for about a week, and after that, the liver is mature enough to excrete bilirubin on its own.

In cases of severe jaundice where phototherapy is not effective, a baby may need to have a special blood transfusion in which their blood is replaced (exchanged) with donor blood to wash the bilirubin out of their system.

Are there any long term problems from jaundice?

There are usually no long-term problems following jaundice in babies. Babies who have had high levels of jaundice should have their hearing checked at regular intervals. This is best discussed with your doctor or early childhood nurse. Brain damage due to very high levels of jaundice is now extremely rare because the levels are carefully monitored while babies are in hospital.

This is one of a series of articles I’ve written for the L’il Aussie Prems newsletter under the heading of Premmie Health. Read my disclaimer here.

A red letter day

Today was my birthday (old, even older than when I was pregnant and didn’t people go on about “advanced maternal age” even then!) and also the date of Talia’s 8 month check up.

As before our four month check up, we were sent a questionnaire to complete in advance of the appointment. In contrast to the previous time, we were delighted to be able to tick “yes” to many of the questions, including almost all of those relating to fine motor skills. She can pick up items as small as a sultana. There were still a few “not yet”s, including two of the gross motor skills - rolling and crawling. However we are much less worried about Talia’s development overall than we were 4 months ago, when she was clearly showing delays in many areas.

The actual meeting with the paediatrician was relatively short, and he told us that he considered all her development to be within normal ranges, with the possible exception of her speech development. Talia babbles happily, but doesn’t use many consonants. It might be that she is not hearing everything clearly, so he arranged for us to see an audiologist to double check Talia’s hearing. Of course it might just be that she is taking her own time - the same way she has been setting her own timeline for other milestones.

In the waiting room we met up with Talia’s boyfriend Reuben who was born the same day, at a similar gestation. He has always been bigger, and now at 8 months corrected he is around 10kg, has been crawling for weeks and is already cruising the furniture. In fact he is doing better than the full term babies in my mothers group who are the same age!

Talia herself is almost 7kg - 6960g to be exact, and nudging the 10th percentile. Four months ago she was only about 4.5kg and so far below the 3rd percentile that I was stressing myself into a state of depression. Thank goodness times have changed and all for the better. Her length is a little below the 10th percentile, although with the amount of wriggling going on I’d be amazed if they actually took a correct measurement. Most amazing though, was the head circumference. This has always been bigger than anything else, but when I put it on the chart after we returned home I couldn’t believe it - 90th percentile, up from less than the 75th. I guess those brains will come in handy, especially if she turns out to be as bad at sport as her parents.

As I’m writing this post it’s the end of the day and I’ve blown out a candle and made a birthday wish - to see my daughter continue to grow happily and healthily, and tick off all those boxes as “yes” eventually.

Hip hip, hooray!

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This post was originally written for the main LAP blog and can be seen at http://www.lilaussieprems.com.au/blogs/02/our-8-month-corrected-check-up/

Talia’s first interstate adventure

At the end of January, Daddyfeatures, Talia (7.5 months corrected) and I took our first flight together, from Perth to Sydney.

It was a big milestone, because before Talia arrived we travelled interstate and overseas quite a lot, and we were upset to be told by hospital staff that we would not be able to fly with Talia for ages because of her chronic lung disease. Fortunately her lungs improved rapidly once she finally came off CPAP (after 11 weeks) and oxygen (a further week), and at the four month check up our paediatrician said it would be OK to fly although he didn’t recommend doing it during winter.

I was 16 before I flew for the first time, so in comparison Talia is definitely quite advanced for her age!

I hesitate to call visiting family interstate a holiday, because it was just as much work as being at home (especially with my father-in-law’s wife in hospital for the duration), but it did have some highlights.

In particular, it was great to meet my LAP friends Pixie and LouCC in Canberra, and Julia (lilronan) in Sydney - and all the other prems. It was especially lovely to introduce Talia R to Talia G. Cuteness plus plus plus.

We also caught up with other friends we hadn’t seen for 18 months - it’s easy to forget how quickly time passes when you are tied up with baby things, especially when you have an unexpected 3 months of hospital visits on top of the usual chaos.

The Sydney branch of the extended family were delighted to see Talia (and didn’t mind seeing us either) and showered her with gifts and cuddles. The weather was abysmal but fortunately we hadn’t come with any plans for sightseeing.

Talia enjoyed a bunch of “firsts” - first flight, first time out in the rain (she was too small the last time it rained in Perth!), first taste of gefilte fish, first posh restaurant… the latter due to Marion being in hospital and Michael’s father not being keen on takeaway. We ended up in a very chic Double Bay eatery with friendly waiters who gave us a table with a bench seat packed with fancy cushions. I wish I’d had my camera.

From a practical perspective, the trip was very successful - we took our own portacot and pram, checked in electronically to get seats with a bassinet, hired a high chair and a car with a baby seat in Sydney, made up a batch of home-cooked baby food on arrival and Talia just rolled with everything, although by the time we’d driven to and from Canberra she was well over long distance car travel, and she finally decided that the morning boob service was no longer required either.

You can never predict these things, but in the one week we were away, every other baby in our mothers’ group (and most of the mums as well) came down with a dreadful gastro bug. So our timing was perfect.

Now we are looking forward to the next trip - a bigger and better adventure!