Thursday, December 28, 2006
Jaundice is common problem with newborns

By Dr. Anthony Policastro

One of the common problems that we see in newborns is something called jaundice. Most people know that it is related to the yellow color of the skin in some newborn infants. What most people do not understand is just how many things can cause a baby to develop jaundice. The yellow color in jaundice comes from a chemical called bilirubin. Bilirubin is a waste product of the breakdown of red blood cells. When red blood cells get old, they die off. The red coloring comes from another chemical called hemoglobin. The body takes the hemoglobin and breaks it down. The result is the formation of bilirubin. The bilirubin goes through the blood stream to the liver. In the liver, it is attached to a sugar molecule. The liver then sends the bilirubin in the bile to the intestine. It goes through the intestine and comes out with the stool. Some of the bilirubin in the intestine is separated from the sugar molecule. It then goes back into the blood stream. It finds its way back to the liver where the process begins again. In normal adults the bilirubin level is about 1-2 mg. Before delivery, the bilirubin goes across the placenta. There the mother's liver handles its removal. After delivery, the infant's liver must begin to handle it. It takes about three days for the liver to begin to do that. In the meantime the level of bilirubin builds up in the bloodstream. In newborns the normal level at three days of age is about 8 mg. Since the process is so complicated, there are many things that can increase the level of bilirubin in a newborn. For example, the baby may have extra red blood cells to break down. This can happen if a baby develops a bruise from a difficult delivery. The blood cells in the bruise break down and form bilirubin. This can also happen if the baby is born with a high red blood cell count. There will be extra cells to break down. Some mothers and babies have different blood types. In these cases, the antibodies from the mother cross the placenta. They then start to destroy the babies' blood cells. Extra cells are broken down so there is more bilirubin. In the 1950s this used to happen with mothers who were Rh negative and had Rh positive babies. We now can treat that. Now it is more likely to occur when the mother is type O and the baby is type A or B. Mothers who have diabetes during pregnancy have problems with sugar metabolism. The result is that the babies do not do a very good job of attaching the bilirubin to the sugar molecule at first. This allows the bilirubin to back up in the blood stream. Liver problems can interfere with the process. Newborns with hepatitis will develop jaundice. Premature infants with immature livers will take longer than three days to start handling the bilirubin. Blockage of the bile ducts will cause a backup of bilirubin. Some babies are born with inherited problems in their metabolism of bilirubin. Those infants will have jaundice. One of these is a rare condition called breast milk jaundice. These mothers have a protein that interferes with bilirubin metabolism. It occurs after 7 to 10 days of age. It is not present in the first few days of life. Once the bilirubin reaches the intestine, there are problems that can occur there as well. An infant who is not taking much milk will have very little fluid in the intestine. This results in what appears to be a high concentration of bilirubin in the intestine because of the low amount of fluid. The body tries to even things out by sending more bilirubin back into the bloodstream where the level is lower. In other infants the bacteria in the intestine break the sugar apart from the bilirubin. This allows more of it to go back into the bloodstream. There is a substance in breast milk that also allows more of the bilirubin to go back into the bloodstream. In infants who are breast fed, they have three factors that make their bilirubin higher in the first few days of life. One is that they have little fluid in the intestine until the mother's milk comes in. The second is that they have the substance in the breast milk that allows more bilirubin to go back into the bloodstream. The third is that the kind of bacteria that breast fed infants get in their intestine is the kind that breaks the sugar apart from the bilirubin. The good news is that these bacteria are not the infection causing bacteria that bottle fed babies get. It is better for a newborn to have a little jaundice than it is to have an infection. There are few newborn issues that are more common than jaundice. There are fewer still that are more complicated than jaundice.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.

Nanticoke Health Services Auxiliary annual meeting
Members of the Nanticoke Health Services Auxiliary will hold the annual business-meeting luncheon on Wednesday, Jan. 10, at the Seaford Golf and Country Club. The regular business meeting will be held at 11 a.m., with the annual meeting and luncheon at 11:30 a.m. Janet Hubbard, president of the Auxiliary, will present the annual financial gift to Rex Mears, president of Nanticoke's board of directors. Board members and administration leaders at Nanticoke will also attend as special guests of the auxiliary. The auxiliary is a vital part of Nanticoke, giving thousands of volunteer service hours in addition to the monetary gift, which includes scholarships to those entering the health-care field. Those persons desiring to become members may contact Jan Grantz, 628-8478, membership co-chair.

Alzheimer's Assn. to hold Family Caregiver Training
The Alzheimer's Association Delaware Valley Chapter sponsors The Family Caregiver Education Series four times per year in each of Delaware's three counties. LifeCare at Lofland Park, 715 King St. in Seaford will host the training on Jan. 25, from 8:30 a.m. until 4:30 p.m. This program includes a Medical Overview; Legal and Financial Issues; Communications, Behaviors and Activities of Daily Living and Community Resources. This training for family caregivers is free and lunch will be provided, but pre-registration is required by Jan. 17, 2007. For additional information or to register, please call Jamie Magee, Branch Office Coordinator, at (302) 854-9788.

Easter Seals introduces Buy a Brick Campaign
Help "pave the way to independence" for people with disabilities by participating in Easter Seals' Buy a Brick Campaign. All bricks will help construct a patio at the Easter Seals Tunnell Center, located at 22317 DuPont Blvd. in Georgetown. This wheelchair-accessible patio, featuring the Easter Seals' lily design, will help people with disabilities enjoy the outdoors. "Purchasing a personalized brick is an affordable way to leave a lasting, positive impact on the community and help people with disabilities become more independent," said Randy Clour, vice president of development at Easter Seals. Those wishing to participate in the campaign can design and order their personalized bricks online at Bricks can be personalized to honor a family member, Easter Seals staff member or participant, or local business, and are tax-deductible. Bricks are $125 for a 4x8 inch brick with one to three lines of inscription, or $250 for an 8x8 inch square brick with one to six lines of inscription. For more information, contact Clour at 800-677-3800 or

Delaware Healthy Living Expo planned
The Delaware Healthy Living Expo, featuring an array of speakers and workshops on issues of family, physical, spiritual, financial, emotional, and intellectual wellness, will be held at the Chase Center on the Riverfront in Wilmington on March 10 from 10 a.m. to 4 p.m. Headlining the workshop programs will be Lisa Whaley, founder and president of Life Work Synergy, LLC. Whaley, who is also an accomplished author, will present "Finding the Off Switch in an Always On World" to give insight to attendees on finding a harmonious balance between work and life. Four additional speakers will follow addressing healing, self-sabotage, positive attitudes, and exercise. The day also features several exhibitors, providing attendees with products, services and knowledge which support health, harmony and spiritual awareness and enhance overall quality of life issues. Admission to the Expo is $7. A special luncheon package is also available for $17. You may preregister online at For more information, visit or call 215-968-4593.