Newborn knowledge Newborn knowledge (January 13, 2006)

By Dr. Tim Lee

Q: What is jaundice?
A: Jaundice is the yellowish skin discoloration seen commonly in newborns, caused by the build up of a chemical in the skin called bilirubin. In older children and adults, bilirubin is metabolized by the liver. In newborns, the liver is immature and not yet able to efficiently process bilirubin. Additionally, the mother's breast milk supply is often limited in the first few days of the baby's life, which leads to decreased bilirubin excretion.

While jaundice is usually benign, excessive build up of bilirubin in a newborn can affect the developing brain and result in neurological damage. In rare cases, a high level of bilirubin can cause hearing loss, learning disability and, in severe cases, seizures and mental retardation. Close monitoring by the pediatrician regularly prevents such avoidable complications. Bilirubin levels can be checked by a simple blood test.

Jaundice usually does not require more intervention than just continued feeding of the newborn, but your pediatrician may prescribe phototherapy (intensive light treatment) for your baby. This is often as easy as exposing your infant to sunlight, though serious cases can require treatment in the hospital.

Q: How do doctors detect internal problems, like enlarged kidneys, in newborns?
A: Doctors give each newborn a thorough physical examination within the first 24 hours of life. They examine the general shape of the baby's abdomen and also check the size, shape, and position of internal organs, such as the kidneys, liver and spleen. Enlarged organs, seen on prenatal ultrasound, can be a sign of a developmental malformation. Ultrasounds or other tests are sometimes done after birth to recheck them. Fortunately, most abnormalities resolve after birth and require little or no intervention.

Routine blood screening for many types of chemical disorders is also done in the nursery.

Q: My newborn has not been feeding well and his soft spot looked sunken. Why?
A: A sunken fontanelle (the "soft spot" on the newborn's head) is one of several symptoms of dehydration. Newborns and infants of both genders are susceptible to dehydration. Other symptoms are dry mouth, decreased or absent urination, sunken and dry eyes, wrinkled skin, and, in extreme cases, even shock or a coma. Dehydration in babies is most commonly caused by poor feeding, persistent vomiting and/or diarrhea from any cause, and persistent high fever. If your newborn shows any of these symptoms, give them very small amounts of breast milk or formula every 30 minutes. If they are unable to keep the fluids down due to vomiting, or they have persistent diarrhea, they should be seen by their pediatrician. In severe cases of dehydration, intravenous fluids may be needed.

Q: What are the best ways to relieve a newborn's discomfort from a bad cold?
A: Even healthy babies typically catch several colds before their first birthday. Keep your infant hydrated and encourage frequent feedings. If you're breast-feeding your baby, keep it up. Breast milk offers extra protection from cold-causing germs.

Keep your baby's nasal passages clear with a rubber-bulb syringe. Running a humidifier in the baby's room can help too. Your baby's doctor may recommend saline (salt water) nose drops or nasal spray to loosen thick nasal mucus.

Most colds are just a nuisance, but it's important to take your baby's signs and symptoms seriously. If your baby is younger than 3 months old, call the doctor at the first sign of illness, because colds can quickly develop into croup, pneumonia or another serious illness.

Prevention is the best tactic. Everyone should wash their hands frequently, especially before touching or feeding your baby. Clean your baby's toys and pacifiers often. Keep your baby away from anyone who's sick and, if possible, avoid public transportation with your newborn.
Tim C. Lee, M.D., is a Camino Medical Group pediatrician.

E-mail questions to Camino Medical Group representative Cynthia Greaves at greavec@caminomedical.org.

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