Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Jaundice in newborns most commonly occurs because their livers are not mature enough to remove bilirubin from the blood. Jaundice may also be caused by a number of other medical conditions.
Physiologic jaundice is the most common form of newborn jaundice. The baby's liver plays the most important part in bilirubin breakdown. The type of bilirubin that causes the yellow discoloration of jaundice is called unconjugated
or indirect bilirubin. This form of bilirubin is not easily removed from the baby's body. The baby's liver changes this unconjugated bilirubin into conjugated
or direct bilirubin, which is easier to excrete. The liver of a newborn baby is
immature, so the job of conjugating and removing bilirubin is not done
completely well. This causes an elevation of bilirubin, which results in the yellow discoloration of the baby's
eyes skin. As the breakdown of red blood cells slows down, and the baby's liver matures, the jaundice rapidly disappears. When jaundice is due to these factors alone, it is termed physiologic jaundice.
Neonatal jaundice can be seen in cases of maternal-fetal blood type incompatibility. The mother's body will actually produce antibodies that attack the fetus's blood cells. This causes a breakdown of the red blood cells and thus an increased release of bilirubin from the red cells.
Healthy red blood cells can be destroyed in a condition called hemolysis.
Polycythemia is a condition in which a child is born with an excess of red blood cells.
A large scalp bruise called a
cephalohematoma can occur during the birthing process. Such a bruise is
really a collection of clotted blood just beneath the skin surface. As the
body naturally breaks down this clotted blood, a large amount of bilirubin
is released at once. This sudden excess in serum bilirubin may be too much for the baby's liver to handle, and jaundice will develop.
Sometimes a baby swallows blood during birth. This swallowed blood is broken down in the baby's intestines and absorbed into the bloodstream. Just as the excess blood from a blood clot will cause a rise in serum bilirubin, so will this.