Jaundice and the Circumcision
Jaundice in A Newborn
Jaundice is a common condition in newborn infants. It is usually not dangerous. The word jaundice comes from the French word “jaune,” meaning “yellow.” It describes the yellowish or light orange appearance of the whites of the eyes and skin of many newborn babies.
Physiologic or “normal” jaundice usually appears on the second or third day of life in healthy babies born after a full-term pregnancy. It often disappears within a week. About 50% of full-term infants get physiologic jaundice. In premature babies, it is even more likely to develop. About 80% of infants born prematurely will have jaundice during the first week of life. It may last longer in these infants, becoming most noticeable between the fourth and seventh days of life.
In most instances, the jaundice is so mild that it can be ignored. It usually will disappear without treatment. However, if the condition is more severe, or if the jaundice is present at birth or appears during the first 24 hours of life, treatment most likely will be necessary.
In most babies, jaundice occurs because the liver and other organs are not yet fully mature. This is particularly true in low-birth-weight or premature babies.
One function of the liver is to rid the blood of a yellowish substance called bilirubin (billy-ru-ben). All during life, and especially just after birth, new red blood cells are being created, and old ones are being destroyed. As the old cells are broken down, a substance in the cells known as hemoglobin is changed into bilirubin and removed by the liver. Until a baby’s liver begins to function fully, bilirubin tends to build up in the baby’s bloodstream, causing the skin and the whites of the eyes to become yellow in appearance.
The color change progresses from head to toe, so an infant with mild jaundice may appear yellow only on his face, while one with severe jaundice will be yellow over his entire body. After being changed by the liver, most bilirubin is removed from the body through a baby’s bowel movements. Anything that increases the number of bowel movements (such as frequent feedings) will help get rid of the bilirubin.
Physiologic jaundice is the usual or expected amount of jaundice frequently seen in infants. This is different from pathologic jaundice, which is caused by an illness or other medical problem. For example, if a baby and mother have different blood types, the mother may produce “antibodies” that destroy the newborn’s red blood cells. This condition, called “Blood Group Incompatibility,” can cause a sudden serious increase in bilirubin.
Jaundice and Breastfeeding
Early onset jaundice may be seen in the first week of life. In breastfed babies, jaundice is very often caused by a baby not getting enough breast milk. Because he is not drinking very much, his bowels are not moving, and the bilirubin cannot be removed from the body in the stools. The best way to treat this is by breastfeeding more frequently (at least 8 to 10 times per day). This will cause the bowels to move more often and remove the bilirubin from the baby’s body. Giving extra water will not help. Frequent breast feedings, throughout the day and night, may help prevent jaundice.
Late onset jaundice can be seen in the second and third weeks of life. Bilirubin levels remain higher than normal, but almost never reach a dangerous level. This is probably due to a substance in the breast milk that interferes with the removal of bilirubin. Usually no treatment is necessary for this type of jaundice. Occasionally a mother may be asked to stop nursing for 1 or 2 days and use an alternative feeding method. It is important that a mother pump her breasts during this time so she can begin to breastfeed again as soon as the bilirubin level has fallen.
The level at which jaundice may be dangerous depends on many factors: the baby’s age, whether he was full-term or premature, and whether he has any other medical conditions. When the bilirubin level becomes too high, jaundice can be dangerous to a baby’s developing nervous system. This happens very rarely. If your doctor is concerned that your baby may have serious jaundice, a very small sample of your baby’s blood will be taken to measure the bilirubin to see if it is close to a dangerous level.
When a baby’s jaundice does require treatment, a technique called phototherapy is generally used. Phototherapy simply means treatment using light. Light—either sunlight or artificial light—speeds up the removal of bilirubin from the body. In phototherapy, the baby’s skin is exposed to special, high-intensity fluorescent lights, often called “bililights.” All the baby’s clothes are removed, and his eyes are covered to protect them from the light. In some cases, a fiberoptic phototherapy blanket may be used to provide this treatment.
Phototherapy continues until the amount of bilirubin in the baby’s blood falls to and remains at a safe level. The bilirubin level is checked regularly by testing a small sample of blood, frequently taken from the baby’s heel. Some babies may need to stay in the hospital for a short period after the phototherapy is finished to make sure that the bilirubin level doesn’t rise again.
Babies with severe Blood Group Incompatibility or other very serious forms of jaundice may need different and more rapid treatment. The most common and effective method is an exchange blood transfusion. During an exchange transfusion, a slender catheter or tube is inserted into a large vein in the baby’s navel. The infant’s blood is very gradually withdrawn and replaced with donated blood. In this way, the excess bilirubin is removed from the baby’s body. Exchange transfusions have been used safely and successfully for more than 30 years, and usually result in dramatic and rapid recovery.
If your baby has jaundice, you undoubtedly will want additional information about its cause and treatment. The baby’s doctor or nurse can answer your questions about your infant’s condition.
Jaundice and Circumcision:
Jewish law considers jaundice to be a reason to postpone the Brit. The mohel will monitor the bilirubin count and may postpone the Brit even if a physician has diagnosed the condition to be normal and harmless.
When the bilirubin count is 11 or higher, the mohel may postpone the Brit and wait a full day after the condition has cleared.
When the bilirubin count surpasses 15, the Mohel will wait for the count to go down to a level under 10 and then wait a full seven days before performing the Brit.