Navigate newborn jaundice with confidence. Meri Sehat provides expert tips and support for parents to ensure the well-being of their newborns.

Jaundice In Newborns

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Neonatal jaundice, also called hyperbilirubinemia, is an excess of bilirubin in a baby&rsquo;s blood. 
&nbsp;

Jaundice in newborns is a common condition worldwide. Approximately 60% of full-term newborns and 80% of preterm newborns develop clinical jaundice during the first 2 weeks after birth. While it is not a serious issue, some newborns may require readmission to the hospital.<a href="#accordion">[1]</a>

Several studies suggest that Asian and African regions have the highest incidence of severe neonatal jaundice, mainly due to late presentation, the high prevalence of glucose-6-phosphate deficiency, the inability of caregivers to instantly identify jaundice, and their decision to seek alternative treatments.<a href="#accordion">[3]</a>

In South Asia, specially, severe hyperbilirubinemia is the 7th leading cause of neonatal mortality.<a href="#accordion">[2]</a> 
&nbsp;

There are 2 types of newborn jaundice:<a href="#accordion">[4]</a>

<ul>
	<li>Pathological &ndash; Jaundice is due to another underlying condition (e.g., a viral or bacterial infection) or certain medications (e.g., antibiotics) which cause a buildup of bilirubin in blood; typically appears on the first day after birth</li>
	<li>Physiological &ndash; Jaundice due to normal newborn conditions, such as a newborn&rsquo;s immature liver; typically appears on the second or third day after birth and clears on its own once the liver develops</li>
</ul>

Physiological jaundice is the more common of the two, making up nearly 75% of cases. 
&nbsp;

Sign and Symptoms

These include:

<ul>
	<li>Yellowing of the skin, eyes, and under the tongue</li>
	<li>Unusual drowsiness; they can be less responsive, hard to wake up, or fussy</li>
	<li>Changes in the color of urine and stool &ndash; very light yellow or very dark brown</li>
	<li>Poor feeding or sucking; refuse breast or bottle for more than 2 feedings in a row, whereas the child normally feeds every 2-2.5 hours a day</li>
	<li>Unusual <a href="https://merisehat.pk/article/the-truth-about-weight-loss-35086">weight loss</a></li>
</ul>

It is hard to see the typical &ldquo;yellowing&rdquo; in darker skin tones. Caregivers should press their finger lightly on the skin and see if the spot appears paler and more yellow. It is best seen in natural lighting.<a href="#accordion">[4]</a> 
&nbsp;

Causes

Bilirubin is a yellow substance made from the breakdown of red blood cells. It is normal for a baby&rsquo;s bilirubin level to be slightly high during the initial days.

The mother&rsquo;s placenta is responsible for removing bilirubin from the fetus&rsquo; body. When the baby&rsquo;s liver takes over this job after birth, it needs some time to do it efficiently. Moreover, newborns produce more bilirubin than adults. The increased production and breakdown of red blood cells that the liver is unable to filter as quickly lead to an excess of bilirubin. 
&nbsp;

Sometimes, babies get jaundice due to:

<ul>
	<li>A chemical in the mother&rsquo;s breast milk interferes with the baby&rsquo;s ability to get rid of bilirubin</li>
	<li>Problems with breastfeeding cause dehydration</li>
	<li>Certain birth interventions and delayed umbilical cord clamping</li>
	<li>an underlying disorder, including sepsis, internal bleeding, and hypothyroidism</li>
</ul>

In rare instances, incompatibility of the mother&rsquo;s and baby&rsquo;s blood groups and biliary atresia may cause jaundice in babies. 
&nbsp;

Diagnosis

Babies are usually screened in the first 24 hours post-birth to predict if they will develop jaundice. The doctor will watch out for signs of jaundice during the time spent at the hospital and during follow-up visits after the baby goes home.

The baby&rsquo;s bilirubin level peaks when they are 3-5 days old. The healthcare provider may place a probe on the baby&rsquo;s head to check the transcutaneous bilirubin level.

If the result is high, they will then order a blood test to confirm the results. The serum total bilirubin level also helps assess the severity of the condition. 
&nbsp;

The American Academy of Pediatrics&#39; newborn jaundice level chart can help determine whether the newborn needs treatment:<a href="#accordion">[6]</a>

<ul>
	<li>&gt;10 mg (less than a day old)</li>
	<li>&gt;15 mg (1-2 days old)</li>
	<li>&gt;18 mg (2-3 days old)</li>
	<li>&gt;20 mg (3 days or older) 
	&nbsp;</li>
</ul>

Treatment

Mild cases of jaundice usually resolve on their own within 1-2 weeks as the baby&rsquo;s liver function improves. If the condition is due to an underlying health problem, such as an infection, it needs to be treated first.

However, in case the bilirubin level is too high or continues to rise during this period, doctors may suggest either phototherapy or exchange transfusion.<a href="#accordion">[7]</a>

During phototherapy, the baby is placed under a special type of light either in an incubator or a cot to boost liver activity. It may be stopped for 30 minutes to enable caregivers to feed, change, or comfort the newborn. 
&nbsp;

In cases where the jaundice does not improve, the process is intensified. This may require using another source of light, such as a light blanket, or increasing the amount of light. No breaks are allowed during intensified phototherapy. Doctors also monitor the temperature and check for signs of dehydration. The baby may be given expressed milk or intravenous fluids if need be.

After phototherapy has begun, doctors will test the baby&rsquo;s bilirubin level every 4-6 hours. Once the level is stabilized, it is checked every 6-12 hours. Treatment is stopped when it reaches a safe level.

Although phototherapy is usually successful and has fewer side effects, it may not work in certain cases and doctors then proceed with an exchange transfusion or replacing a small amount of the baby&rsquo;s blood with donor blood of the same blood group. 
&nbsp;

This may take a lot of hours to complete and needs to be closely monitored throughout the time to ensure timely interventions for complications like bleeding. The baby&rsquo;s blood is tested within 2 hours to check whether the treatment worked. If not, the process may need to be repeated. 
&nbsp;

If left untreated, severe jaundice can lead to potentially life-threatening conditions such as acute bilirubin encephalopathy and kernicterus that damage the brain and spinal cord. 
&nbsp;

These include:

<ul>
	<li>Preterm infants</li>
	<li>Babies who are exclusively breastfed</li>
	<li>Genetics or family history</li>
	<li>Certain ethnic groups, particularly those of East Asian or Mediterranean descent</li>
	<li>Delayed passing of the first stool</li>
	<li>Male 
	&nbsp;</li>
</ul>

Early and regular check-ups for newborns can help avoid any complications of jaundice through monitoring of bilirubin levels, treating underlying conditions promptly, and ensuring proper feeding and nutrition intake for the infant. 
&nbsp;

Key Points

<ul>
	<li>Neonatal jaundice, also known as hyperbilirubinemia, results from the accumulation of bilirubin, a yellow pigment produced during the breakdown of red blood cells.</li>
	<li>There are two types of neonatal jaundice: physiological and pathological.</li>
	<li>It is characterized by the yellowing of the skin and eyes, poor feeding or sucking, and changes in urine and stool color.</li>
	<li>Causes and risk factors for jaundice in newborns include certain underlying conditions, blood group incompatibility, G6PD deficiency, and premature birth.</li>
	<li>The preferred treatment for jaundice in newborns is phototherapy.</li>
	<li>Untreated, severe jaundice can lead to kernicterus, causing brain damage.</li>
	<li>Preventive measures for jaundice in newborns include regular checkups to monitor bilirubin levels while ensuring proper feeding and nutrition.</li>
</ul>

[1] Ansong-Assoku B, Shah SD, Adnan M, et al. Neonatal Jaundice. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

[2] Mir SE, van der Geest BAM, Been JV. Management of neonatal jaundice in low- and lower-middle-income countries. BMJ Paediatr Open. 2019;3(1):e000408. Published 2019 Feb 14. doi:10.1136/bmjpo-2018-000408

[3] Diala UM, Usman F, Appiah D, Hassan L, Ogundele T, Abdullahi F, Satrom KM, Bakker CJ, Lee BW, Slusher TM. Global Prevalence of Severe Neonatal Jaundice among Hospital Admissions: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2023; 12(11):3738.