I work as a tutor for the nursing program at my former college. Right now,
the students are trying to understand lactation, jaundice, what to do with
the baby...

The information the students are given is to give water supplements to
"flush jaundice." Depending on the nurse, or which hospital, practice here
is to give water supplements when a baby become jaundiced, or give dha/ara
formulas because they do such a good job of clearing out the intestines.

There is so much confusion on what to do, and why, so we looked at this
yesterday.

If all goes well, the baby should have excess red blood cells (RBCs) after
birth. Red blood cells break down after the birth, the iron stays in
circulation to prevent anemia, and a component of the RBC becomes
unconjugated bilirubin. 

Unconjugated/indirect bilirubin is NOT water soluble, and must be broken
down by an enzyme in the liver to become conjugated/direct. The direct moves
on to the kidneys where it is filtered out, and then excreted in urine.

However, newborn babies do not have this enzyme (because their livers are
immature), and cannot break down the indirect bilirubin into direct. They
are kind of "stuck" at the indirect stage, and have to have fat to break
down the bilis so they are released in stool. (It is the other way around in
an adult, few bilis are released in the stool, most of it is excreted in
urine.) If the stool remains in the intestines, the components are
reabsorbed, and the pigment, jaundice, will stain tissues leading to the
yellow skin tone.

If there is a better way of understanding/explaining this, let me know. This
is what we came up with to figure out the chapter, and I feel really bad for
the students, because they know the reason for not offering water, but if it
comes up on their test, they will be forced to choose the wrong answer.

Sam :o)

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