Newborn Jaundice

Some newborn babies develop jaundice. But there is nothing to panic as this is quite common. However if left untreated, it could be dangerous to your little one. Learn the causes of newborn jaundice and how it is treated.

Last Updated: 23 October 2020

Newborn Jaundice
Newborn Jaundice
What is newborn jaundice?

Newborn jaundice is also called neonatal jaundice. It’s nothing but when your baby’s skin and white part of his eyes appear yellow, within a few days after birth. This yellow coloration is due to accumulation of bilirubin in your baby’s blood.

Bilirubin is produced during the normal breakdown of red blood cells. The liver is responsible for breaking down the bilirubin so that it is eliminated from the body through stools. New born have a higher concentration of red blood cells, so there are higher levels of bilirubin in their blood (compared to adults).

Most premature and some full term babies develop newborn jaundice. Since a premature baby’s liver is not mature enough to process the bilirubin, there is an accumulation of it in the blood and the end result is jaundice.

As the baby’s liver gets matured, it can filter the bilirubin and the jaundice goes away. If it persists for more than three weeks, adequate treatment is required to prevent further damage.

Symptoms of newborn jaundice

You may notice yellowing of baby’s skin and white part of the eyes (sclera) between the second and fourth day after birth. This starts at the head and typically spreads to chest, stomach, arms and legs. If you gently press your baby’s forehead or nose, and it turns yellow, that may be a sign of mild jaundice. Other common symptoms include:

·         Extreme drowsiness and sluggish

·         Trouble in breastfeeding or sucking from a bottle

·         Baby passes dark and yellow urine (baby’s urine should be colorless)

·         Pale stools

If you notice a high pitched crying, stranger eye movements and high fever, you must report to your doctor immediately.

Causes of newborn jaundice

Physiological Jaundice- During pregnancy, bilirubin is removed via the placenta. After birth, sometimes a baby’s liver may not be matured and so jaundice can occur. This is the most common form and it resolves on its own as the baby’s liver develops.

Breast-feeding jaundice - occurs in the first week of life. If the baby finds difficulty in feeding, there will be fluid insufficiency which in turn increases the levels of bilirubin. Once the baby receives adequate milk, this form of jaundice can disappear.

 Breast milk jaundice – Sometimes substances in the breast milk interfere with the breakdown process of bilirubin. This occurs when a baby is 7-11 days old. If the bilirubin levels go very high, doctors may ask you stop feeding temporarily until the levels reach normal.

Premature babies may develop jaundice as their liver is not fully functional to filter out bilirubin.

Some of the other causes of newborn jaundice include

·         Internal bleeding

·         Blood group incompatibility between mother and child

·         Liver malfunction (like hepatitis, cystic fibrosis)

·         Enzyme deficiency

·         Infection in baby’s blood

·         Bruising during childbirth

·         Red blood cell enzyme or red blood cell membrane defects

Diagnosis of newborn jaundice

The American Academy of Paediatrics (AAP) recommends that all newborns should be examined for jaundice before discharge from the hospital and also after 3-5 days of birth. The levels of bilirubin tend to peak between 3 and 7 days after birth; hence it is important to have a checkup a few days after birth.

Some of the ways to diagnose newborn jaundice are:

1. Physical examination: The doctor checks for any yellow coloration in your baby’s body and enquires whether any abnormality is seen in baby’s stools and urine.

2. Measurement of bilirubin:

Blood test: A blood sample will be drawn from the heel of your baby and the levels of serum bilirubin will be measured using bilirubinometer.

Skin test: A beam of light will be passed on the baby’s skin. Using a transcutaneous bilirubinometer, the doctor calculates the level of bilirubin based on the light reflection off the skin or the amount of light the skin absorbs.

The normal range of bilirubin in a newborn baby is below 5mg/dl. If the level of bilirubin is higher than 5mg/dl, it means the baby has neonatal jaundice. The following table is a representation of serum bilirubin levels in healthy and premature newborns who require treatment for jaundice.

Age of the baby

Serum bilirubin levels (in healthy newborn)

Serum bilirubin levels (in premature newborn babies)

Less than 24 hours

Above 10 mg

8 mg/dl or higher

24-48 hours

Above 15 mg

13 mg/dl or higher

49-72 hours

Above 18 mg

16 mg/dl or higher

>72 hours

Above 20 mg

17 mg/dl or higher

 

Sometimes a physician may request for other blood investigations if the jaundice persists for more than two weeks. These blood tests include complete blood count (CBC), blood group compatibility, Coombs test to check for increased red blood cell breakdown.

Treatment of newborn jaundice

As the baby’s liver gets matured enough, mild jaundice resolves on its own within two weeks. Breastfeeding your baby (8 to 12 times a day) helps in eliminating the bilirubin.

Severe jaundice requires treatment as follows:

1. Phototherapy:  In this therapy, a baby will be placed on a special bed under a blue spectrum light.  The baby will be wearing only a diaper and eyes are protected with special goggles. A fiber-optic blanket may also be placed underneath your baby. During this treatment, photo oxidation occurs, which adds oxygen to bilirubin so that it can dissolve in water. The liver then metabolizes bilirubin in the blood and removes it from the body. This treatment is safe for babies.

2.  Exchange transfusion: If phototherapy does not work well for your baby, an exchange transfusion will be performed in which your baby’s blood will be replaced with fresh (donor) blood. This replaces the baby’s damaged blood with healthy red blood cells and reduces the levels of bilirubin .

 

Jaundice is normal and there are no ways to prevent it. Breastfeeding cures mild jaundice. In severe cases, careful monitoring and appropriate treatment is required. 

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