Jaundice in newborns is super common, where your baby’s skin and eyes turn yellow. You need to monitor for jaundice symptoms because they mean there’s bilirubin in the blood. This is because of too much bilirubin, a yellow pigment produced when red blood cells break down. About 60-80% of full-term babies get jaundice within the first week of birth. Symptoms usually show up 2-4 days after delivery.
What is Jaundice and What Causes Jaundice in Newborns
Neonatal Jaundice
Physiological jaundice is a common and harmless condition in newborns. This type of jaundice is because the baby’s liver is still maturing and producing more bilirubin and not eliminating it as well.
When does it appear? 2-3 days after birth
Commonality: 60% of full-term babies and more in premature babies
Resolution: Most cases resolve within 1-2 weeks without treatment.
So, why does this happen? When babies are born, their bodies have to start processing bilirubin on their own. Bilirubin is a yellow pigment produced when red blood cells break down. In newborns, the baby’s liver is still developing and not efficient in eliminating bilirubin. This immaturity of the baby’s liver results to higher levels of bilirubin in the blood and the yellowing of the skin and eyes.
Pathological Jaundice: Hyperbilirubinemia
Unlike physiological jaundice, pathological jaundice in newborns means there’s an underlying medical condition and not just a natural buildup of bilirubin. This type of jaundice is more serious and usually needs medical attention.
Causes: Several conditions can cause pathological jaundice:
Blood type incompatibility with the mother (e.g., Rh or ABO incompatibility): This can cause the baby’s red blood cells to break down too fast and bilirubin to build up in the baby’s blood. May require blood transfusions or other treatments for the underlying condition.
Hemolytic disorders: Conditions where red blood cells are destroyed faster than they can be made and bilirubin increases.
Infections: Infections present at birth can impair the liver’s ability to process bilirubin.
Metabolic disorders: Disorders that affect the baby’s metabolism can affect bilirubin processing.
These conditions can cause excessive bilirubin production or impaired bilirubin processing. Unlike physiological jaundice, pathological jaundice needs medical attention to address the underlying condition.
Knowing the difference between physiological and pathological jaundice helps parents understand why monitoring bilirubin levels and seeking early medical advice is important for newborns. Pathological jaundice needs closer monitoring and treatment to manage the underlying condition.
Diagnosis
Jaundice in newborns is usually diagnosed through visual assessment. Jaundice first appears on the face and then goes down as bilirubin levels increase.
But visual assessment alone is not always reliable:
Babies with darker skin tones may not show yellowing as clearly.
Those who have undergone phototherapy may also be difficult to detect visually.
To get an accurate diagnosis, doctors usually order a blood test from a heel prick to measure Total Serum Bilirubin (TSB). This test will determine the exact bilirubin level in your baby’s blood. Measuring your baby’s bilirubin level is important because it will help determine the severity of jaundice and if treatment is needed. Elevated bilirubin levels may require medical attention to prevent complications.
Sometimes, additional tests are needed to rule out other conditions:
Thyroid function tests
Liver function tests
Complete blood count
These tests will help determine if there are underlying conditions contributing to the jaundice and will give a clearer picture of your baby’s health.
Treatment Options
A. Phototherapy
In the past, parents were advised to expose their newborns with jaundice to morning sunlight. This was to use UV light to break down bilirubin in the skin. But this method is no longer recommended because:
Sunburn: Newborns have very sensitive skin that can burn easily.
Overheating: Prolonged exposure to sunlight can cause overheating.
Uncontrolled Light Intensity: Natural light is not controlled, so it’s hard to manage UV exposure.
Harmful Radiation Exposure: Direct sunlight has harmful UV rays that can damage the baby’s skin and eyes.
Instead, phototherapy is now the common and effective treatment for newborn jaundice.
Phototherapy involves placing your baby under blue spectrum lights. These lights will break down bilirubin in the baby’s skin and turn it into a form that can be processed by the baby’s immature liver and excreted through urine and stool.
Phototherapy Facts:
Non-invasive: Baby lies in an incubator or under the light while wearing only a diaper and eye protection.
Safe and Controlled: The intensity and wavelength of light are controlled to ensure safety and effectiveness.
Duration: Duration of treatment varies depending on bilirubin level but usually several hours a day for a few days.
Monitoring: Bilirubin levels will be monitored regularly to check the effectiveness of phototherapy and when to stop.
Phototherapy is used because it’s safe, effective and can be done in the hospital or at home with portable phototherapy units under medical supervision.
Other treatments are feeding adjustments, medications in severe cases and exchange transfusion in rare instances, all to manage bilirubin levels effectively.
B. Feeding Adjustments
Babies with jaundice often have poor feeding, which can lead to initial weight loss. Frequent feeding will help increase bowel movement and help eliminate bilirubin from the body. Here’s how:
Breastfeeding: Make sure your baby is latching well and feeding every 2-3 hours.
Supplemental Feeding: In some cases, formula supplementation may be needed to maintain hydration and nutrition.
Hydration: Keeping your baby hydrated is key in managing jaundice.
Frequent and effective feeding will support your baby’s overall health and reduce bilirubin levels naturally.
C. Medication (in severe cases)
In severe cases of jaundice, when phototherapy is not enough, medication may be given. These medications will reduce bilirubin levels in the blood:
Intravenous Immunoglobulin (IVIG): Given that jaundice is caused by blood group incompatibility, IVIG can reduce the need for exchange transfusion.
Phenobarbital: Sometimes used to induce liver enzymes that will process bilirubin.
Please note that these medications are usually reserved for severe cases of jaundice and is given under strict medical supervision.
D. Exchange Transfusion (Rare Cases)
In severe cases of newborn jaundice where bilirubin level is very high despite of phototherapy, an exchange transfusion may be needed. Bilirubin is produced when red blood cells break down and excessive bilirubin can build up in the blood causing jaundice.
Exchange transfusion is a procedure where a baby’s blood is gradually removed and replaced with donor blood. This will:
Lower bilirubin levels quickly
Remove antibodies that may be causing the jaundice
Replace damaged or abnormal red blood cells
This is rarely used but can be life-saving for infants with severe jaundice due to underlying conditions such as hemolytic disease or severe liver abnormalities.
Complications
A. Short-term effects
When jaundice in newborns is mild, it usually resolves on its own without any long term effects. But it’s important to know the short-term effects that may occur.
Yellowing of Skin and Eyes: One of the most obvious signs is the yellow discolouration of your baby’s skin and the whites of their eyes. This happens because bilirubin, a yellow pigment, accumulates in the blood faster than the baby’s liver can process it.
Lethargy and Poor Feeding: Babies with jaundice may seem more sleepy or lethargic and may have poor feeding. This can make it difficult for them to get enough nutrition.
Dehydration: Due to poor feeding, some babies may not get enough fluids and may be dehydrated.
Weight Loss: Initial weight loss can occur due to inadequate feeding during the first few days.
Temporary Hearing Problems: In some cases, high bilirubin level can affect a baby’s hearing temporarily.
In severe cases where bilirubin levels become very high, bilirubin can enter the brain. This is called acute bilirubin encephalopathy. Symptoms may include:
Extreme Lethargy: Baby may be very sleepy or hard to wake up.
High-pitched Crying: Abnormal high-pitched cry may indicate distress.
Arched Posture: Baby may exhibit unusual body posture, like arching their back.
If left untreated, severe jaundice can lead to kernicterus. Kernicterus is a rare but serious condition that causes permanent brain damage due to the toxic effect of high bilirubin levels on brain cells.
Most babies have mild jaundice, which is resolved with minimal intervention. Early treatment is key to preventing complications and your baby’s health. If symptoms persist or worsen, always seek medical advice immediately.
B. Long-term effects (If left untreated)
If jaundice is left untreated, it can lead to kernicterus. Kernicterus is a rare but severe condition where a high level of bilirubin causes brain damage. Long-term effects on infants may include:
Hearing loss: Damage to the auditory pathways can cause permanent hearing problems.
Cerebral palsy: Movement disorders due to brain damage.
Intellectual disability: Problems with cognitive development and learning.
Untreated jaundice can also lead to serious conditions like obstructive jaundice, which requires immediate medical attention.
Early treatment is key to preventing these outcomes.
Conclusion
Jaundice is common among newborns, up to 80% of full term infants are affected. It appears within the first few days after birth and usually resolves on its own without intervention. Physiological jaundice is harmless, but pathological jaundice needs medical attention because of underlying health conditions.
Phototherapy and feeding adjustment can manage jaundice. In severe cases, medication or exchange transfusion may be needed. Regular follow up is important to monitor bilirubin level and your baby’s health.
Parents, it’s normal to worry if your baby has jaundice. I, myself, was born with jaundice and was treated under phototherapy for about a week or two. Remember, most are harmless and will resolve quickly. Consult your healthcare provider for guidance and advice tailored to your baby’s needs.
Stay informed and be proactive—your baby is in good hands!
