Jaundice refers to the yellowish discoloration of the skin and the white of the sclera of the eyes. It occurs due to the excessive build-up of a substance known as bilirubin in the blood.
Bilirubin is released in the body as a result of the breakdown of the old or damaged red blood cells. The liver plays a key role in the removal of bilirubin from the body thus preventing jaundice.
However, in newborn babies, the liver is not fully developed. As a result, bilirubin begins to accumulate in the body causing jaundice. Jaundice in newborn babies usually occurs due to the normal rise in the breakdown of the red blood cells and their immature livers that are not efficient at processing and removing bilirubin from the blood circulation.
How does neonatal jaundice develop?
As the bilirubin level in the neonate rises, jaundice or the yellowish discoloration of the skin begins to appear from the head. It later involves the arms, chest, and abdomen, finally affecting the skin of the legs.
When the bilirubin levels rise to a very high level, the baby appears jaundiced over the palms and below the knees.
An easy way to check for neonatal jaundice is to gently press a finger against the baby's skin, to push the blood out of it temporarily. It causes the normal skin to turn white. However, the jaundiced skin would stay yellow, suggesting the possibility of the build-up of bilirubin in the blood.
Adults and older children tend to develop jaundice when the bilirubin level in their blood becomes higher than 2 mg/dL (milligrams per deciliter). In newborn babies, jaundice begins to appear when the bilirubin level rises higher than 5 mg/dL.
It is important to identify and treat neonatal jaundice as the high level of bilirubin may cause permanent damage to the baby's brain. This form of brain damage is known as kernicterus.
Today, due to the increased awareness and advanced treatments for neonatal jaundice, the incidences of complications like kernicterus have become extremely rare.
What are the symptoms of newborn jaundice?
Neonatal jaundice itself does not produce any evident signs. However, the underlying abnormalities may produce some symptoms such as:
- Poor feeding
- Fever
- General appearance of sickness
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What are the causes of newborn jaundice?
The treatment of jaundice depends on the specific cause of it. Hence, it is important to identify what caused neonatal jaundice so that the treatment can be aimed at correcting the specific abnormality.
Jaundice in newborn babies almost always occurs due to their immature livers that are not efficient enough to eliminate bilirubin from the blood. It may also occur due to a number of other medical conditions as explained below.
Physiologic jaundice
It is the most common type of newborn jaundice, which occurs when the baby's liver fails to remove bilirubin from the blood circulation.
The type of bilirubin, which causes the yellowish discoloration of the skin and sclera in this form of jaundice, is known as indirect or unconjugated bilirubin. It can not be removed from the body easily. Hence, the baby's liver changes indirect bilirubin into its easier-to-excrete form called direct or conjugated bilirubin.
Since the liver of newborn babies is not fully mature, the activities involved in conjugating or removing bilirubin do not occur in an efficient manner. This can cause bilirubin to build up in the body, resulting in the yellowish discoloration of the eyes and skin.
Neonatal jaundice
Jaundice in neonates may occur due to the incompatibility between the maternal and fetal blood types.
Some other causes of jaundice in newborn babies include:
- Hemolysis
- Polycythemia
- Cephalohematoma
- Swallowing of blood during birth
- Gestational diabetes in mothers during pregnancy
- Crigler-Najjar syndrome
- Lucey-Driscoll syndrome
Our AARC Approved CEUs for doctors are aimed at evaluating the causes of jaundice in newborn babies and providing information about the treatment for each. Healthcare professionals can attend our CEUs to learn more about the causes and treatments of this condition.
Treatment of neonatal jaundice
In most cases of jaundice, the treatment is needed only when the baby has a very high level of bilirubin in the blood.
Most babies do not need any active medical intervention as the symptoms tend to resolve spontaneously over a period of time. The condition often improves within 10 to 14 days after birth and does not cause any harm to the baby.
When treatment is not needed, the mother can continue to breastfeed or bottle-feed the baby regularly.
If the child’s condition becomes worse or if jaundice does not resolve even after two weeks, medical intervention may be needed.
The treatments are usually aimed at reducing the risk of serious complications including kernicterus. The treatment may include:
Phototherapy
It is a type of treatment that involves exposure to a special type of light. The exposure to light makes it easier for the baby's liver to process and remove bilirubin from the blood.
During phototherapy, the baby's body temperature is monitored to ensure he or she does not develop hyperthermia. The baby is also checked regularly for the signs of dehydration.
Exchange transfusion
If the bilirubin level becomes too high and phototherapy does not produce the desired results, the child may need advanced treatments like a complete blood transfusion.
During a complete blood transfusion, the baby's blood is removed through a plastic tube placed into the blood vessels of the arms, legs, or umbilical cord. The blood is then replaced with the blood from a matching donor.
This allows the level of bilirubin in the baby's blood to fall quickly.
If jaundice is caused due to any other health problem, like an infection, the treatment needs to be modified accordingly.
Conclusion
A majority of newborn babies with jaundice recover fully without developing any permanent adverse effects.
Healthcare professionals can attend our AARC Approved CEUs for Nurses to learn the latest treatment options for managing jaundice in newborn babies and the most effective ways to minimize the risk of complications.