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.
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.
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.
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:
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.
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.
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.
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.
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.
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:
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:
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.
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
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 |
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:
Although neonatal jaundice is common, newborns with some risk factors are more prone to developing jaundice. Some of the risks factors include:
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:
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:
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:
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:
In conventional phototherapy, babies are placed under halogen lamps or fluorescent lamps. During the procedure, the babies’ eyes are well-covered.
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.
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.
In mild cases, the doctor might suggest home remedies for jaundice in newborns. Following are some home remedies:
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:
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:
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.