What to expect in newborn prolonged jaundice

There are many reasons (multifactorial) for newborn baby jaundice. Some are normal events (for Asian babies), whereas in rare cases they are due to insidious reasons.

First week

After given the green light to go home (especially with acceptable jaundice level), baby will still be susceptible to increased bilirubin (biological product that causes jaundice), especially when he/she drinks just mother's milk. There are two main means to remove bilirubin, i.e. urine and stool. If baby's urine is pinkish/reddish, it is an indication of blood/hemoglobin in urine (e.g. hemoglobinuria as experienced by our baby) which can indicate ABO incompatibility (e.g. mother's antibody is attacking baby's blood cells) which is common for parents with different blood type (see below). After discharge from hospital, parents are required to visit polyclinics to monitor their babies' bilirubin level (every two days). The result mostly will show an increase in bilirubin level (if it reaches a threshold, hospitalization and phototherapy will be required). To minimize the chance of going back to hospital, babies should be given sufficient amount of milk for him/her to pass both yellowish urine and stool. Some doctors don't encourage sun-bathing babies (but morning sun should be harmless). Alternatively, getting a portable photo-therapy assembly is good (if ABO incompatibility is suspected; good hospitals will check baby's blood type and compare it with mother's).

ABO incompatible arises when mother, father and resultant baby's blood types.

Second week

After second week when the bilirubin still persist on the high (even after healthy amount of passing urine and stool), it is still normal considering that baby's liver is still not fully functional. Visit to the clinic is still at two days intervals. There is nothing much the doctor can do except prescribe the next visit.

Third week

If the jaundice level is still high. It is time to add milk with formula. Although we wanted fully breast milk, but jaundice and re-visiting the clinic is not permitting that ideal. The best way to beat baby jaundice is to add milk with formula for the day-feeds and fully breast milk during the night-feeds. You will realize that the amount of stool will increase tremendously. Giving our baby fully breast milk at night prevents constipation (milk is mild laxative whereas formula can cause constipation). 

Normally if jaundice is still high, doctor will prescribe liver function test. Our baby has normal liver function.

Subsequently

After introducing formula at 1/3 part of daily feed, our baby's jaundice stabilized. The jaundice still come-and-go but by the look of the skin and white eye, our baby is getting better.

What we wished our hospital provided

• Blood type test on baby (we had to ask for it)
• Portable photo-therapy assembly for rent (when required)
• Step-by-step expectation if jaundice level persisted. Although the hospital encourages fully breast milk for babies, persistent jaundice is an indication that breast milk is not enough and a compromise is needed.