Neonatal Jaundice

While you are basking in the joy of the arrival, of your newborn baby, you might notice your baby’s skin looks yellow. This can cause you to panic and worry. In such a scenario, your family doctor might be the best person to consult. However, there’s no need to worry because this can be infant jaundice or neonatal jaundice that occurs in preterm babies and some full-term babies. It occurs in many newborn babies. Although it is not harmful, it can cause problems, if untreated. Read on and equip yourself with enough information so that you can handle it effectively and without anxiousness.

What is Neonatal Jaundice?

Bilirubin is a yellow-coloured material that the human body creates during the process of replacing old red blood cells in the blood. The liver helps in breaking down the bilirubin so that it is flushed out of the body through stools. The level of bilirubin is low in adults when compared to the new born babies, also referred to as neonates. The concentration of red blood cells in babies is higher. Therefore, there is an increase in the normal range of bilirubin for newborn baby. Neonatal jaundice occurs when the blood of the babies indicate a high level of bilirubin. This level contributes to a change in the colour of the baby’s skin and the whites of his eyes as it turns yellow. This condition in babies due to the high unconjugated bilirubin levels is known as Neonatal Jaundice.

This yellow coloration of the skin and the whites of the eyes due to neonatal hyperbilirubinemia indicate a normal transitional phase. However, it can be fatal in some babies, if not treated.

How Common is Jaundice in Newborn Babies?

Around sixty percent of full-term newborns and eighty percent of preterm babies develop a yellow coloured skin – called jaundice – during the first week or two. Generally, all newborn babies have some jaundice, but it’s not always evident. Often, jaundice is a common and transient physiological consequence of the baby’s immature liver. Handling ababy with jaundice is an expected scenario in hospitals that specialize in newborn babies. For many babies, this is a harmless, yet a temporary condition that disappears on its own or with appropriate treatment. However, in some cases, it’s very critical, so it is vital to be cautious.

What Are the Causes of Neonatal Jaundice?

Human blood contains bilirubin. When old red blood cells break down, bilirubin is one of the substances that is created. Generally, bilirubin is removed by the liver from the blood and the body. After removal the liver gets rid of it through urine and bowel movements. Higher levels of the pigment, bilirubin in the blood causes the skin to appear yellow. Jaundice occurs as bilirubin in newborns is more than can be disposed. Following are the forms of jaundice depending on the various causes:

• Physiological Jaundice
• Breastfeeding jaundice
• Breast Milk jaundice
• Blood Group Incompatibility jaundice

Physiological Jaundice

During pregnancy, the placenta grows to feed the baby. As the baby is in your womb, your body removes the bilirubin from the baby through the placenta. After the baby is born, the baby’s liver must get rid of the bilirubin. It might take time for the baby’s liver to do this job efficiently. So, the bilirubin increases in the baby’s blood and jaundice occurs. This type of jaundice is referred to as physiological jaundice. Usually, it appears during the second or third day and disappears within two weeks. The yellow colour appears all over the skin and reaches the toes, at times.

Breastfeeding Jaundice

The concentration of the bilirubin in the blood shoots up if there is insufficient liquid. So, your breastfeeding baby would be affected with breastfeeding jaundice if it is not receiving plenty of breast milk. Discussing your feeding problem with your doctor or consulting a lactation expert can help you handle this type of jaundice. After the baby receives adequate milk through proper feeding methods, frequent and increased feedings, the jaundice will disappear.

Breast Milk Jaundice

During the first few weeks, breastfeeding babies might develop breast-milk jaundice. Typically, this type of jaundice is diagnosed when the baby is around 7 to 11 days old. The baby would be gaining weight and nursing as required, but the breast milk might be affecting the liver’s capability of processing the bilirubin. This can continue for many weeks or even months. It occurs in babies that are predominantly breastfed. It is harmless; however, if the baby’s bilirubin level goes very high, the doctors might advise you to stop feeding the baby with breast milk for a few days. When the bilirubin level regains its normalcy, you can breastfeed the baby.

Blood Group Incompatibility

Incompatibility in the blood groups of the mother and the baby can cause jaundice. This maternal-foetal blood group incompatibility leads to increased bilirubin levels during the breakdown of the baby’s red blood cells.

Prematurity

Babies who are born earlier than 37 weeks of pregnancy have a higher risk of getting jaundice, when compared to full-term babies. In premature babies, the liver is not fully developed to remove the bilirubin. So, the babies end up developing jaundice.

Other Causes of Neonatal Jaundice

Sometimes, jaundice might be caused due to reasons, such as infections or an issue with the baby’s digestive system. Jaundice can also occur under the following conditions:

• Blood infection or sepsis
• Red blood cell enzyme or red blood cell membrane defects
• Internal bleeding
• Maternal diabetes
• Polycythemia (Elevated Red Blood Cell Count)
• Bruising during childbirth
• Galactosemia – metabolisim of the sugar galactose isn’t properly carried out
• Enzyme essential for disposal of bilrubin is deficienct
• Hypothyroidism
• Cystic fibrosis
• Hepatitis
• Thalassemia (blood disorder with defective production of hemoglobin)
• Biliary atresia – one or more ducts of liver is blocked
• Crigler-Najjar syndrome – inherited disorder that affects the metabolism of bilirubin

What Are the Signs and Symptoms of Jaundice in Newborns?

Hyperbilirubinemia symptoms vary depending on the cause of the jaundice and the level of bilirubin increase. Following are some of the signs and symptoms that can indicate that the baby has jaundice:

• Yellow-coloured skin is one of the most visible signs of jaundice. Neonatal jaundice skin symptoms first appear on the face and then move on gradually to the other parts of the body.
• Drowsiness is a symptom of severe jaundice.
• Neurological signs such as seizures, high-pitched crying, muscle tone changes might occur. These signs must be attended to immediately to avoid complications.
• Baby passes dark and yellow urine
• Baby is not feeding or sucking appropriately
• Hepatitis and biliary atresia increase the conjugated bilirubin level. This increase results in jaundice, which is signified by pale stools and dark urine
• Yellow coloured sclera is another predominant sign. In extreme cases, the limbs and abdomen display yellow colouration.

Diagnosis and Tests

Your doctors will examine the baby for jaundice from birth. Ideally, they would observe him for three to five days after birth because the bilirubin levels in newborns can be highest during this period. There are various tests for diagnosing jaundice in newborns. Let us look at some of these tests.

• Visual Examination – This is the first and most common methods used for diagnosing jaundice. The doctor undresses the baby and examines the skin under good lighting. He would examine the sclera of the eyes and also the gums. He would ask you questions regarding the baby’s urine and stool colours to determine whether it could be jaundice.
• Bilirubin Tests – If the doctor has doubts that the baby has jaundice, he would prescribe blood tests to confirm his doubts. There are two types of blood tests:
  • Transcutaneous Bilirubinometry – To perform this test, the doctor uses a device known as bilirubinometer. Through this device, a beam of light is directed on the baby’s skin. The device calculates the level of bilirubin in the baby’s blood depending on the light reflecting off the skin or the amount of light the skin absorbs.
  • Using a Blood Sample – The doctor takes a blood sample from the heel of your baby and a pathologist checks the bilirubin level in the serum. Usually, doctors prefer the bilirubinometer.

Bilirubin Levels In Newborns

The bilirubin test in newborn determines the bilirubin levels. The normal range of bilirubin in a newborn baby is below 5mg/dl. If the level of the bilirubin is higher than this normal value, the baby has neonatal jaundice.

Source: https://www.caringforkids.cps.ca/handouts/jaundice_in_newborns

Bilirubin level in healthy newborn baby

The following bilirubin chart indicates the serum bilirubin level in healthy newborn babies who require treatment for jaundice:

Age of the Baby	Serum Bilirubin Levels
Less than 24 hours	Above 10 mg
24 – 48 hours	Above 15 mg
49-72 hours	Above 18 mg
Older than 72 hours	Above 20 mg

Bilirubin level in premature newborn baby

The following bilirubin chart indicates the serum bilirubin level in premature newborn babies who require treatment for jaundice:

Age of the Baby	Serum Bilirubin Levels
24 hours old	8 mg/dl or higher
48 hours old	13 mg/dl or higher
72 hours old	16 mg/dl or higher
96 hours old	17 mg/dl or higher

Other Tests – If the doctor thinks more tests are required based on the severity, the following investigations are done through blood tests:

• Blood group compatibility
• Complete blood count of the bay
• Determining enzyme deficiency or infection
• Testing red blood cells and checking if antibodies are attached to them

Risk Factors

Although neonatal jaundice is common, newborns with some risk factors are more prone to developing jaundice. Some of the risks factors include:

• If the babies have siblings who have had neonatal jaundice
• If they are preterm babies, born before 37 weeks of pregnancy, they might not be able to process bilirubin quickly. They might feed less and so have lesser bowel movements, which reduce the amount of bilirubin released.
• Babies who have feeding difficulties
• Babies whose mothers are diabetic
• Babies with bruises or cephalohematoma. If babies have bruises during delivery, there are chances of the babies developing jaundice.
• Dehydration might contribute to the onset of jaundice.
• Mother-baby blood group incompatibility
• Congenital infection
• Occurrence is higher in East Asians and American Indians and minimal amongst Africans.

What Are the Possible Risks and Complications of Jaundice in Newborns?

Severe neonatal jaundice might have major complications. Therefore, it is required to consult your doctor and treat accordingly, on time.

Following are some complications that the baby can develop:

Acute Bilirubin Encephalopathy

Bilirubin is harmful to the brain cells. Severe cases of jaundice can be risky and lead to the bilirubin reaching the brain. This condition is referred to as acute bilirubin encephalopathy. If it is not treated, it causes irremediable damage to the brain. The following symptoms might indicate that the baby is affected with acute bilirubin encephalopathy:

• Fever
• Difficulty waking
• Vomiting
• Poor sucking or feeding
• Backward arching of the neck and body
• High-pitched crying

Kernicterus

If acute bilirubin encephalopathy results in irreversible or permanent damage to the brain, it results in a syndrome referred to as Kernicterus. This syndrome can cause the following damages:

• Permanent upward gaze
• Uncontrolled and involuntary movements known as athetoid cerebral palsy
• Improper development of tooth enamel
• Hearing loss

Treatment Options for Neonatal Jaundice

If the jaundice is mild, it will disappear within two to three weeks. If the condition is moderate or severe, the baby must be treated to decrease the bilirubin levels. Following are some of the popular treatments:

• Phototherapy
  If your baby has moderate neonatal jaundice, phototherapy is given. This treatment uses light to bring down the bilirubin levels. Due to this light treatment, photo-oxidation occurs. Photo-oxidation adds oxygen to bilirubin so that it can dissolves in water. This enables the liver to metabolize the bilirubin in the blood and remove it from the body. Phototherapy for baby are safe and it will last for two to three days, with a gap after every three to four hours. During the gap, you can feed the baby. The bilirubin levels are constantly monitored. Sometimes, the baby might develop a tan, but it would disappear soon. There are two types of phototherapy:
  • Conventional Phototherapy

In conventional phototherapy, babies are placed under halogen lamps or fluorescent lamps. During the procedure, the babies’ eyes are well-covered.

• • Fibre-Optic Phototherapy

In the fibre optic phototherapy, the babies are wrapped in a blanket called biliblanket, which contains fibre-optic cables. Light travels through these cables and envelops the baby. This treatment takes one to two days. The baby is fed once in two hours to avoid dehydration. This treatment is used for premature babies.

• Exchange Transfusion for neonatal jaundice

If the baby’s bilirubin levels do not decrease by phototherapy, doctors perform exchange transfusion wherein a small quantity of the baby’s blood is removed and replaced with a donor’s blood. The donor’s blood would not contain bilirubin and so this will decrease the bilirubin levels after the transfusion. The exchange transfusion for neonatal jaundice is a long process. The baby is carefully monitored. Two hours after the process, blood tests are performed to determine whether the procedure was successful.

Newborn Baby Jaundice Treatment at Home

In mild cases, the doctor might suggest home remedies for jaundice in newborns. Following are some home remedies:

• The doctor might recommend change in the feeding patterns. Frequent feeding helps in removing the excess bilirubin through excretion. Breast-fed babies must have 8 to 12 feedings a day.
• If the baby is having trouble during breast-feeding, the doctor may suggest giving expressed milk or formula to supplement feeding.
• Supplement of sunlight can also help the baby. You can hold the baby in a sunny room so that they feel the warmth. Do not expose to direct sunlight.
• If the jaundice occurs due to the breast milk, your doctor might advise you to stop feeding for a day or two.

Prevention

Jaundice is normal is babies and cannot be prevented. However, you can prevent it from becoming severe by proper screening, monitoring, and prompt treatment . Following are some tips for your reference:

• High-risk babies must be monitored closely and treated to prevent complications.
• Pregnant mother’s blood group must be tested for blood group and presence of unusual antibodies. If the mother is detected to be Rh negative, the infant must be tested to ensure that it is not affected.
• You must ensure that the baby is well-hydrated during the first few days after birth so that excess bilirubin is flushed out.
• You must observe the baby’s skin colour and other symptoms of jaundice so that the baby is treated on time.

When Should You Call the Doctor?

Hospitals check for jaundice in babies before discharging them. It is advisable to take follow-up appointments during the first few days and check with the doctor to ensure that the baby is fine. Generally, doctors will check babies between the third and seventh day after birth because during this period the bilirubin levels are high. Before discharge, parents must be educated about jaundice and advised to come back to the hospital, if required.

If you find some of the signs and symptoms of jaundice, it is advisable to call the doctor. Call your doctor in the following scenarios:

• Baby’s skin becomes more yellow, including its abdominal regions, legs and feet
• The whites of the baby’s eyes look yellow
• The baby seems finds difficult to awaken
• The baby makes high-pitched cries
• If your baby has jaundice for more than three weeks

Conclusion

Jaundice in a newborn baby makes parents anxious, worried, and tensed. However, advancements in medical sciences ensure that your little one gets the appropriate treatment. If you are aware of the symptoms of neonatal jaundice, you can observe the baby during the initial few days and get it treated. It is important to educate yourself all about neonatal jaundice so that you do not panic.

Although newborn jaundice is not harmful, for some babies it gets severe. High levels of bilirubin affects the brain, so it is advisable to observe the baby, diagnose and treat promptly to ensure that it does not cause permanent damages. The pointers in this article will help parents understand everything about neonatal jaundice and act accordingly, if required.