First, I don't normally get into bilirubin in parent's classes unless
they bring it up.  I do use the guidelines (I think it was in
Reardon/Auerbach) showing that the jaundice spreads from face and eyes,
then to chest, then out the extremities-so the further out the arms and
legs it goes, the higher the levels.  I usually suggest if they can
press over the elbow or knee and the "flash" (capilary refill) when they
release the pressure is yellow instead of white, have the doc take a
look.  Since I'm seeing mom in my office in the hospital, I usually call
the doc at their office, report my observations, and they usually have
mom stop down in lab for a bili draw.  Now there is a very accurate skin
meter that's used on the OB unit that we hope to be able to use when we
see mom/babies as outpatients and avoid the need for heel pricks..

Anyway, how to explain it in simple terms:  Baby needs a higher
concentration of red blood cells in utero than he does once "on the
outside".  Therefore, in the first days of life, baby is breaking down
and processing more red blood cells than the usual day-to-day recycling
that occurs throughout life.  Unfortunately, sometimes baby's little
liver can't quite cope with the large amount of waste it has to process,
so the waste products are temporarily stored until the liver catches
up.  This shows up in skin as a yellow color.
(further comment if appropriate:) Some of this is very normal.  Experts
disagree on how high the "normal" levels are.  Some have even raised the
question; Since it occurs to some extent with most babies, should we
worry about the ones with "low" levels?

While certainly not a complete scientific treatise, I think this is
sufficient for most parents.  i think it is important to point out the
normalness of some levle of jaundice.  For many adults, their only
exposure to jaundice may have been another adult who had it in
conjuction with some serious disease or condition.  In adults, it is
usually a sign of something serious, so they transfer this seriousness
to their baby.  It helps when they realize that jaundice is a SYMPTOM,
not a disease in itself.

Winnie

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