Thursday, January 04, 2007
The problem of jaundice in newborns: part 2

By Dr. Anthony Policastro

Last week I wrote about how complicated the process of jaundice is in the newborn period. Interestingly the treatment is a lot less complicated. In the 1950s there was a newborn nursery that noted an odd fact. Babies in one part of the nursery got jaundiced. Babies in another part did not. They found that the difference was sunlight. Babies on the sunny side of the room did not get as much jaundice. This led us to discover the fact that light indeed affected jaundice. Babies get yellow because of the chemical bilirubin. Light on the skin affects the bilirubin in the skin. It breaks it down into a harmless waste product. Thus the treatment for jaundice is to put the baby under fluorescent lights. This artificial sunlight provides the needed source of light to help resolve the jaundice. The problem is deciding which babies need to spend time under the lights. There are a number of things involved in this. The first is the level of bilirubin. The higher the level, the more the need for lights. As I indicated the last time, adult bilirubin levels are 1-2. Newborns reach 8 on the average. A level of 25 is considered dangerous for the full term newborn. So we need to treat before it hits 25. Since most babies do not get much above 8, there are not a lot of babies who qualify for treatment. The second thing involved in the decision is the baby's age. Bilirubin increases for the first 72 hours of life. Thus a bilirubin of 10 at four days of age means very little. A bilirubin of 10 at 24 hours of age is serious. That is because we know it will keep going up. The third thing is related to how fast it is going up. A bilirubin may go from 10 at 2 days of age to 11 at three days of age. This is no big thing. However, it may also go from 10 at 2 days of age to 15 at 3days of age. That means it could rise to 20 by four days of age. That is more of a concern. This is the main reason that we keep having babies come back every day for repeat levels. We do that until the level starts to come down. The fourth thing is related to whether the baby is premature or not. A premature infant will have problems with a lower level of bilirubin than a full term baby. Thus we get concerned with levels much lower than 25. The younger the baby, the more concerned we get. The fifth thing is related to whether the infant is sick or well. Sick infants are more likely to have problems at lower levels. Thus if there is a sick premature infant with a high level of bilirubin at an early age, we treat him/her very quickly. There are a number of charts that we use. They show the level of bilirubin and the patient's age. If the level is too high for that age, then we are likely to treat the infant with fluorescent lights. In addition, we also have to decide whether to treat the problem causing the high bilirubin. Those problems are many. Therefore, the treatments are many as well.

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

Dr. Prest to split time between Berlin and Laurel offices
The Primary Care Network of Peninsula Regional Medical Center in Salisbury, Md. has announced that Adebowale Prest, MD, will early in 2007 begin seeing patients four days a week at the Peninsula Regional Primary Care Family Medicine office in Laurel, replacing Dennis Glover, MD, who has left the practice. Dr. Prest, who has been in practice at Peninsula Regional's Family Medicine office in Berlin, Md., since August of 2005 with Peter Abbott, MD and Deborah Conran, DO, will also maintain a presence there and will continue to see patients one day a week at the Berlin office. Dr. Prest, a specialist in Family Medicine, received her medical degree from the University of Maryland School of Medicine. She completed a residency in Family Practice at Ghent in Norfolk, Va. and a fellowship in OB/GYN at Harrisburg Hospital in Harrisburg, Pa. Dr. Prest has also served on the medical staff at Cortland Memorial Hospital in Cortland, N.Y. where she was vice chairman of the Department of Family Medicine. She is board-certified by the American Board of Family Practice. Dr. Prest will join Tammy S. Cahall, CRNP at the Peninsula Regional Family Medicine office in Laurel. Dr. Prest may be reached at the Laurel office, 875-6550.

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 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.

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 details call Clour at 800-677-3800 or

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.