Jaundice

As I’ve admitted before, I’m a worrier.  So when I first saw Martha in the delivery room, I thought she would require a little extra vigilance.  She was red.  Not in the ethnic-slur sense, of course.  But from head to toe, she was a lot redder than most babies.  I worried that she had too many extra red blood cells.  This could be a sign of a problem or it could be a sign of difficulties she had during gestation that her prenatal screening didn’t pick up.  And no matter what the cause, these extra red blood cells break down into bilirubin, which causes jaundice.

Jaundice happens to half or more of all newborns.  (This brings up an interesting question about the definition of ‘normal.’  Surely being jaundiced isn’t normal.  But if the majority of babies get jaundice, isn’t your jaundiced baby normal?  Is your non-jaundiced baby abnormal?)  Sure enough, by the time the baby was 3 days old, her bilirubin level had risen high enough to require a little intervention, in the form of a glowing pad that the parents need to keep next to the baby’s skin.  This helps her body dispose of the bilirubin. 
And I’m a worrier.  So I go over to their house on the first evening they were using this device, to check on the baby and to be sure they were using the gizmo correctly.

I came just as they were sitting down to dinner.  This was a little awkward socially, I admit, but my concern was genuine.  They set another place at the table.

The biggest change in the design of hospitals, and of industrial buildings of all kinds, came about from 3 sequential inventions.  First, electric generation and transmission.  This made the second invention, the elevator, possible.  It became a lot easier to build high and transport sick people without using stairs.  And then air conditioning.  These 3 things were in wide use by the 1950’s.  Prior to this, however, and for many centuries, hospitals were built at the top of the local hill.  There were several practical reasons for this.  The sick were kept away from town.  There was generally good through-ventilation, from big windows facing different directions.  This was important because, in the days before the idea that germs caused disease, the breeze would disperse the contagious miasmas that carried sickness.  And the drainage, often infectious, was good.  Though many or most women gave birth at home, a lot of newborns, especially the sick ones, had stays in the maternity ward.  The babies were often put together (we’ve all seen this in old movies--an expectant father looking through a viewing window trying to find his own in a cluster of newborns).  Long before modern medicine, it was noticed that the babies near the aisle were generally more jaundiced than the babies near the windows.  If where you live was developed before 1900, as in New England (or old England for that matter), think about where the old hospital building was or is.  On a hill, right?

The explanation for this had to wait until the 20th century.  Hemoglobin is the molecule in our red blood cells that carries life-sustaining oxygen everywhere we need it.  When the red blood cells that carry the hemoglobin (they are red from the iron in them) are damaged or worn out, the hemoglobin breaks down.  When we get a bruise, it starts as red or black.  This is from the actual blood under the skin.  The blood cells break down quickly, however, so the ‘black and blue’ stage usually only lasts days.  The hemoglobin content of these cells breaks down into bilirubin, a bright yellow pigment.  This can last for many weeks.  Bilirubin is oily and dissolves easily into fatty tissue, such as skin, fat, and brain.  Because it doesn’t mix well with watery liquids (like blood) it’s stuck in the skin.  Sunlight provides just enough extra energy to shake up the bilirubin molecule and make it a little more soluble in blood.  When this happens, some of the bilirubin leaves the skin, gets taken by the blood to the liver where it is processed and disposed of along with the baby’s other creative output.  It’s why baby poop is yellow.  If the baby needs phototherapy, it’s often safer and more dependable to get the baby under lights that are specifically engineered to be effective and safe.

Since more than half of babies have some jaundice, it’s usually benign.  It usually peaks at about day 3 or so, and gradually declines.  Unless where you live is tropical, it’s hard to get your baby’s skin a lot of sun exposure without letting them get too cold.  And you definitely don’t want a sunburned baby!

There are some good reasons, however, to be vigilant about it.  Many kinds of problems, from innocent to serious, can cause accelerated break-down of those red blood cells.  So the jaundice might be sign that something’s wrong.  And though jaundice is usually benign, and goes away by itself without consequence, it can be very serious at very high levels (a rare event) because it settles in brain tissue.  So jaundice is something I worry about.

Incidentally, as we sat at dinner all the adults told funny stories about our own childhoods and wacky things our parents said to us.  One of those stories will be coming up.