Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids HealthCast by Weill Cornell Medicine. I'm Melanie Colon. Today we're talking about. Bilirubin and jaundice in newborns. Joining me is Dr. Matthew Dang.

He's an assistant attending pediatrician at New York Presbyterian Hospital, Weill Cornell Medical Center, and an instructor in pediatrics at Weill Cornell Medical College, Cornell University. Dr. Dang, thank you so much for joining us to start off, not everybody knows what jaundice really is. They hear about yellow, and that's really all that they know.

Can you tell us what newborn jaundice. Is and how common it is as well.

Dr Matthew Deng: thanks For having me here today, Melanie. I'm glad to be talking about jaundice because it's. So common during the newborn period. jaundice is a medical term we use to describe yellowing of the skin and the whites of the eyes. It happens when there is a higher level of a natural substance called bilirubin that's circulating the bloodstream.

It is very common during the newborn period up to 60% of full-term babies and. 80% of preterm babies, less some degree of jaundice during the newborn period. It's usually part of, the baby's transition as their bodies learn to process bilirubin more effectively.

Melanie Cole (Host): Thank you for that. So when is it considered a normal part of that transition versus something parents should worry about? We get all psyched. We take our babies home and then we start to see some of this. When do we worry?

Dr Matthew Deng: typical newborn jaundice usually starts around day two or day three of life for the baby, and it tends to stay mild and gradually gets better as the baby feeds well and starts having more bowel movements. The yellow often starts on the face and the whites of the eyes, and if bilirubin rises, it can move downwards.

So then it progresses to the chest, to the belly. And then the arms and the legs usually a slow and mild progression like this can be totally expected during the newborn period. But there are a few times when I tell parents to reach out to their pediatrician's office. You know, the first thing is if the yellowing is spreading quickly down the body.

So over a course of several hours, if the baby is very sleepy, hard to wake up for feeds or is not having the expected number of wet diapers for the day. And then the last one is if there's concerns that the stools are pale or gray or white, which is never normal.

And lastly, if something just feels off to you as a parent and you're not sure if it is normal or not, I always recommend giving us a call just to check in.

Melanie Cole (Host): What exactly is bilirubin, Dr. Dang. Tell us a little bit about how the physiology of what's actually happening is.

Dr Matthew Deng: So everyone makes bilirubin, including us. but newborns make more of it for several reasons. Babies are born with a lot of extra red blood cells that they needed when they were still inside the womb after birth. They don't need as many red blood cells, so the body starts breaking down the extra red blood cells that they had, and that process releases bilirubin.

Additionally, the newborn's liver is still learning its job. the liver is the organ that processes bilirubin so that it can leave the body. And in the first few days of life, it's just not fully up to speed quite yet. During this time, babies are still figuring out feeding. We know that good feeding helps move bilirubin through the stool and into the urine, and during the first couple of days, milk intake can be lower and consistent, and this means that bilirubin has a higher chance of building up a little bit faster.

You put all those factors together and it's completely normal for many newborns to look a little bit yellow In the early days.

Melanie Cole (Host): So you mentioned preterm infants before Dr. Dang. Are certain babies more at risk that you're gonna tell the parents to keep a closer eye or you will keep a closer eye on that? Newborn? We hear about breastfeeding, jaundice and breast milk, jaundice, different from formula different. Can you tell us a little bit about risk factors that might put our babies more at risk?

Dr Matthew Deng: So medically there are several factors that causes higher levels of bilirubin in babies. And we always take these factors into account when we decide what is a safe level for an infant. things like prematurity. If there's concerns for blood type incompatibility between the mom and the baby, and babies with certain blood conditions such as G six PD deficiency, are at higher risk for, higher elevation of bilirubin.

Melanie Cole (Host): So then tell us a little bit about treatment. If we notice it moving quickly, if we notice some of those red flags you just pointed out, what do we do? Do we call our pediatrician? Do we go to the emergency room? What does a parent do?

Dr Matthew Deng: So typically before the baby leaves the nursery, everyone gets their bilirubin checked before to make sure that those levels are at a safe level and to make sure that they're not rising too quickly. A lot of times the first follow at the pediatrician's office is determined by. These factors.

so we always make sure that before leaving the hospital, we have a good follow up plan in place, in between hospital discharge and the baby's first appointment. If something feels off and if the yellowing is progressing very rapidly, it's always not a bad idea to give the pediatrician's office a call just to make sure that they don't need to be seen sooner than their scheduled first appointment.

Uh, during the first appointment we usually take a look at the babies, and if we feel the baby's jaundice is on a more moderate level, and we usually check those levels again just to make sure that they remain at a safe level. If those levels are above the level that we need to treat, you know, then we talk about several options.

for babies who are born full term, have no risk factors and who are otherwise feeding well, and seems to be doing well. Otherwise, you know, we may talk about home phototherapy. and then for babies whose levels are rising very quickly, who have certain other medical risk factors, we may talk about readmitting the baby to the hospital to treat.

The bilirubin levels under phototherapy.

Melanie Cole (Host): Tell us what phototherapy is, how does that help? We hear about it and we've heard about the light and all that, but how does that help? What's going on in. Side.

Dr Matthew Deng: yeah. So phototherapy is a easy and extremely safe way to lower bilirubin levels quickly. It uses a very specific wavelength of blue light that interacts with the bilirubin bright on the baby's skin. The lie helps change bilirubin into a form that the baby can eliminate easily without the body or the liver needing to process it first.

So in the hospital with phototherapy, the baby is usually placed in a warm bassinet or a ette, and the blue light shines above and below The baby baby is typically undressed, so the light can reach as much skin as possible, but they're still kept really cozy with temperature monitors and blankets.

It's usually a very common controlled setup, and most babies do very, very well.

Melanie Cole (Host): That is wild. Somebody came up with that. I find that absolutely fascinating. So, are there things that parents can do at home, feeding, strategies, frequencies, anything that you wanna tell us that could possibly help to stave this off? or if it's gonna happen, it's gonna happen in a particular baby.

Dr Matthew Deng: so the. Biggest thing that parents can do at home is to focus on good and frequent feeding. We know that when babies take enough milk, they stay well hydrated, have more wet diapers and stools. and since bilirubin leaves the body mostly through the stool, frequent elimination can help bring the bilirubin levels down.

We usually recommend that newborns need to be fed at least every two to three hours and sometimes more frequently, especially if they're requesting to be fed. This helps make sure that they stay hydrated and it also helps the liver do its job of clearing up bilirubin.

Melanie Cole (Host): Dr. Dang. Are there some myths or outdated beliefs about jaundice that you find yourself correcting quite often? Do. People when they're talking to you about things, what are they saying that you would like to clear up right now?

Dr Matthew Deng: so myth number one that, you know, I find myself talking about a lot during. the newborn period is, if babies look yellow, that something must be seriously wrong. Most es in the first week of life is completely normal and it just happens because babies are still transitioning from life in the womb to life outside, and the livers are still.

Maturing. We monitor jaundice very closely and for most families, it's just a normal part of the newborn period and the jaundice goes away without any issues. The second myth, that we hear a lot about is the treatment for jaundice. a lot of people might believe that putting the baby in the sunlight would fix jaundice completely.

this is a common misconception. Sunlight does contain some of the helpful wavelengths to clear out bilirubin, but there's just not enough of it for it to be a reliable way to treat jaundice. Phototherapy is a much safer and far more effective mode of treatment.

Melanie Cole (Host): This is really great information, especially for new parents to hear. Dr. Dang, you're so educational and informative. I thank you. And for the last. bit of advice here. If you can give new parents one takeaway about bilirubin and jaundice, what would you like them to know?

Dr Matthew Deng: I've had just one takeaway. It's this, Janice is extremely common, and when we catch it early and monitor it closely, it's very manageable. It's not a sign that you're doing anything wrong. It's just a normal part of transition to life outside of the room for many babies. Pediatricians have a lot of experience in dealing with this, and we're here to guide you and make sure that everything stays safe.

Melanie Cole (Host): Thank you so much Dr. Dang, for educating us about bilirubin and jaundice and newborns. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids HealthCast.

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I'm Melanie Cole. Thanks so much for joining us today.

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