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Jaundice in Newborns

What is jaundice in newborns?

Jaundice or hyperbilirubinemia is one of the most common conditions observed during the first few days of a newborn’s life. It is characterized by an increase in the levels of a pigment called bilirubin in the blood, which causes yellowish discolouration of the baby's skin and tissues. Usually the condition is not serious, but complications including brain damage can occur, if not treated promptly.

Why do newborn babies get jaundice?

Jaundice usually occurs due to an increase in the breakdown of red blood cells into bilirubin, because of the shorter lifespan of these cells in babies when compared to adults. The inability of immature liver cells in babies to completely remove the pigment from the blood stream is the cause for jaundice.

Types of jaundice

Physiologic jaundice: It is the most common form, occurring in more than 50% of newborns. The condition appears between the second to fourth day of life and usually disappears by one to two weeks. It occurs due to the slower processing of bilirubin by immature liver cells.

Jaundice due to prematurity: This occurs in premature babies due to the ineffective bilirubin elimination from the blood. Treatment is needed at lower bilirubin level than in term infants, as the risk for brain toxicity are more in premature babies.

Breast-feeding jaundice: The condition is seen in 5 to 10% of newborns during the first week due to reduced intake of breast milk. This could be the result of difficulty in breast feeding or insufficient milk production.

Breast milk jaundice: Such type of jaundice appears in breastfed babies usually after one week of life and may persist till week two or three. It is caused due to the presence of certain factors in the breast milk that reduce the rate of bilirubin breakdown by the liver.

Jaundice due to hemolysis: Mismatching between the blood types of mother and baby (blood group incompatibility) could increase the breakdown of red blood cells, which in turn leads to the accumulation of bilirubin in the blood. The condition, which usually appears in the first 24 hours of life could be fatal without proper treatment.

Why jaundice in newborns should be a concern?

Circulation of the pigment in hazardous levels to the brain tissues could cause reversible (early acute bilirubin encephalopathy) or permanent damages (kernicterus).

What are the symptoms of jaundice?

The most common symptoms to be noted in newborns are:
  • Yellowish discolouration, first evident on the face, eyes, and tip of the nose, which may advance to arms, chest, abdomen, and ultimately to legs.
  • Appearance of yellow colour upon pressing a finger on the baby’s forehead or nose. Assessing the baby’s skin colour in natural day light is preferred.

How is jaundice diagnosed?

The day of onset of jaundice gives an important clue to the underlying cause. Appearance of jaundice on the first day of life always suggests a serious disease and requires immediate medical attention.

Laboratory testing that may aid in diagnosis includes:
  • Red blood cell counts
  • Measuring bilirubin level
  • Blood group compatibility testing (Coombs’ test)
What are the treatment strategies?

Selecting the optimum treatment modality depends upon the cause of jaundice and bilirubin level. The goal of treatment is to ensure that serum bilirubin level is kept normal and brain damage is prevented.

Phototherapy: It is a widely accepted, relatively safe, and effective method for treating jaundice in the newborns. The therapy involves exposure of the baby to special blue spectrum lights throughout the day and night, for one or two days. The position of the baby is changed intermittently to facilitate exposing the whole body, and the baby’s eyes are protected from bright light during the treatment. Phototherapy aids in breaking down bilirubin and eliminating it through stool and urine.

Fibre-optic light treatment: The treatment involves the use of special fibre-optic blanket, either alone or in combination with regular phototherapy. Wrapping the baby in the blanket may help in giving the treatment while holding the baby and during feeding.

Exchange transfusion: The method is adopted for lowering bilirubin when it approaches critical levels and phototherapy is ineffective. The procedure involves exchanging baby’s blood with compatible fresh blood from a donor. It helps in improving the red blood cell count, as well as decreasing the bilirubin levels. The treatment is repeated if the bilirubin level remains elevated.

Treatment for blood group incompatibility: Intensive phototherapy is considered as the first line of treatment. Administration of intravenous immunoglobulin is shown to reduce the need for exchange transfusions in newborns. However, the condition is preventable in future pregnancies if the mother is given an injection of RhoGAM (Rho(D) Immune globulin) within 72 hours following the delivery.

Frequent feeding: Keeping the baby well hydrated by providing adequate milk or supplemental formula is important. This may help in increasing the frequency of bowel movements, thereby eliminating the excess amount of bilirubin through stools.

Prevention

Jaundice is not completely preventable in newborns. However, the following measures may help in early identification, treatment, and prevention of the rise in bilirubin to dangerous levels:
  • Testing pregnant women for blood type and development of unusual antibodies
  • Feeding the baby frequently
  • Careful monitoring of the infant for the first few days of life
Myths and facts

There is a popular misconception that exposing the baby to sunlight is an effective treatment for jaundice. It is not currently advocated due to the risk of sunburn.

 
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