My daughter has neonatal jaundice....what should I do?

Question

My daughter was born 5 days ago at 37 weeks gestation. No complications. Her bilirubin at day 4 was 22 (essentially all unconjugated). Her doctor sent her home and put her under lights. Today (day 5) her bilirubin was 17. However, she is still very lethargic. She is peeing and pooping. What should we be doing? Should she be hospitalized? IV fluids? What's the chance of her developing kernicterus?

Answer 1

Well...

First off, your daughter was not preterm, so that's good.
The chances of developing kernicterus in a fullterm baby is extremely small. A TSB above 25-30 has an increased risk for Kernicterus.

Second off, 22 on day 4 is high (above 95th percentile). But coming down to 17 on day 5 is a GREAT response to the phototherapy! She is now around the 85th percentile...and obviously trending down with the photo therapy (and shows there probably isn't a serious reason behind the high bilirubin).

Since this is such a great response, continuing the phototherapy for another 1-2 days would probably be all that is necessary.

Of course, staying hydrated is key to flush out that bilirubin...and it sounds like your daughter is eating/drinking, given the pooping and peeing. So that's also a great sign.

IV fluids would be unnecessary and cruel and unusual punishment, so to speak. This would only be necessary if she wasn't responding so well to the phototherapy (which she is) or if she wasn't eating/drinking (no wet diapers), or if her TSB had gone from 22 to 25, say...

If all of what you say is exact and true, the chances of your daughter developing kernicterus is just about ZERO.

"Lethargic" is a heavy word, used very differently by doctors than by patients. Most 1 week old babies are "lethargic" in the one sense - they eat, sleep, poop, sleep, eat, sleep, poop, sleep...etc.

But "lethargic" as in...doesn't move arms and legs, very difficult to arouse, not taking the bottle or breastfeeding at all, and not having wet diapers...is a completely different kind of "lethargic", which is much more serious. This WOULD require hospitalization with IV fluids (since she wouldn't be drinking on her own)...and a septic workup looking for a serious bacterial infection (especially if mom was GBS positive and not treated with antibiotics while in labor!).

But it sounds like your daughter is doing great (pooping and peeing...and therefore, eating). She is likely sleeping a lot, as all newborns do, but when awake, moving limbs some and is "sucking" well (bottle or breast). Feeding at her age takes a lot of energy!

Her TSB is trending down very fast...and will likely be in normal range by tomorrow (around 15 is normal for a baby ~6-15 days old).

Sounds like you and your daughter are doing great!

Congratulations on your new baby girl!

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