Neonatal Jaundice: Definition, Causes, Risk Factors, Symptoms, Diagnosis And Treatments

What is Neonatal Jaundice?

Jaundice is yellow discoloration of a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells.

Neonatal jaundice is a common condition, particularly in babies born before 38 weeks' gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby's liver is not mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice.

Most infants born between 35 weeks' gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

Causes of Neonatal jaundice

Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of "used" red blood cells.

Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn's immature liver often can't remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.

Other causes

An underlying disorder may cause infant jaundice. In these cases, jaundice often appears much earlier or much later than does the more common form of infant jaundice. Diseases or conditions that can cause jaundice include:

Internal bleeding (hemorrhage)

An infection in your baby's blood (sepsis)

Other viral or bacterial infections

An incompatibility between the mother's blood and the baby's blood

A liver malfunction

Biliary atresia, a condition in which the baby’s bile ducts are blocked or scarred

An enzyme deficiency

An abnormality of your baby's red blood cells that causes them to break down rapidly.

Risk factors of Neonatal jaundice

Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:

  Premature birth. 

A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.

  Significant bruising during birth. 

Newborns who become bruised during delivery gets bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.

   Blood type. 

If the mother's blood type is different from her baby's, the baby may have received antibodies through the placenta that cause abnormally rapid breakdown of red blood cells.

    Breast-feeding. 

Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breast-feeding, experts still recommend it. It's important to make sure your baby gets enough to eat and is adequately hydrated.

    Race. 

Studies show that babies of East Asian ancestry have an increased risk of developing jaundice.

What are the symptoms of Neonatal jaundice?

Yellowing of the skin and the whites of the eyes, the main sign of infant jaundice usually appears between the second and fourth day after birth.

To check for infant jaundice, press gently on your baby's forehead or nose. If the skin looks yellow where you pressed, it is likely your baby has mild jaundice. If your baby doesn't have jaundice, the skin color should simply look slightly lighter than its normal color for a moment.

Examine your baby in good lighting conditions, preferably in natural daylight.

When to see a doctor

Most hospitals have a policy of examining babies for jaundice before discharge. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital.

Your baby should be examined for jaundice between the third and seventh day after birth, when bilirubin levels usually peak. If your baby is discharged earlier than 72 hours after birth, make a follow-up appointment to look for jaundice within two days of discharge.

The following signs or symptoms may indicate severe jaundice or complications from excess bilirubin. Call your doctor if:

Your baby's skin becomes more yellow

The skin on your baby's the abdomen, arms or legs looks yellow

The whites of your baby's eyes look yellow

Your baby seems listless or sick or is difficult to awaken

Your baby isn't gaining weight or is feeding poorly

Your baby makes high-pitched cries

Your baby develops any other signs or symptoms that concern you.

Complications of Neonatal jaundice

High levels of bilirubin that cause severe jaundice can result in serious complications if not treated.

Acute bilirubin encephalopathy

Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there's a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy. Prompt treatment may prevent significant lasting damage.

Signs of acute bilirubin encephalopathy in a baby with jaundice include:

Listlessness

Difficulty waking

High-pitched crying

Poor sucking or feeding

Backward arching of the neck and body

Fever

Kernicterus

Kernicterus is the syndrome that occurs if acute bilirubin encephalopathy causes permanent damage to the brain. Kernicterus may result in:

Involuntary and uncontrolled movements (athetoid cerebral palsy)

Permanent upward gaze

Hearing loss

Improper development of tooth enamel.

Diagnosis of neonatal jaundice

Your doctor will likely diagnose infant jaundice on the basis of your baby's appearance. However, it's still necessary to measure the level of bilirubin in your baby's blood. The level of bilirubin (severity of jaundice) will determine the course of treatment. Tests to detect jaundice and measure bilirubin include:

A physical exam

A laboratory test of a sample of your baby's blood

A skin test with a device called a transcutaneous bilirubinometer, which measures the reflection of a special light shone through the skin

Your doctor may order additional blood tests or urine tests if there's evidence that your baby's jaundice is caused by an underlying disorder.

Treatment for neonatal jaundice

Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital.

Treatments to lower the level of bilirubin in your baby's blood may include:

  Enhanced nutrition. 

To prevent weight loss, your doctor may recommend more-frequent feeding or supplementation to ensure that your baby receives adequate nutrition.

  Light therapy (phototherapy). 

Your baby may be placed under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in both the urine and stool. During treatment, your baby will wear only a diaper and protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or mattress.

  Intravenous immunoglobulin (IVIg). Jaundice may be related to blood type differences between mother and baby. This condition results in the baby carrying antibodies from the mother that contribute to the rapid breakdown of the baby's red blood cells. Intravenous transfusion of an immunoglobulin, a blood protein that can reduce levels of antibodies may decrease jaundice and lessen the need for an exchange transfusion, although results are not conclusive.

  Exchange transfusion. 

Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood and replacing it with donor blood, thereby diluting the bilirubin and maternal antibodies, a procedure that's performed in a newborn intensive care unit.

Prevention of Neonatal jaundice

The best preventive of neonatal jaundice is adequate feeding. Breast-fed infants should have eight to 12 feedings a day for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week.

Reference:

www.mayoclinic.org