Know About Jaundice in Newborns

 

Jaundice in newborns is very common and needs prompt management and care. Infants suffering from jaundice have a yellowish tint in both their skin and eyes. It arises due to an excess of bilirubin in the baby's bloodstream. Bilirubin, a yellow substance, results from the natural breakdown of red blood cells. The liver's role is to extract bilirubin from the blood and excrete it into the intestines for eventual elimination from the body. In contrast to adults, a newborn's liver is less efficient at processing bilirubin. Jaundice occurs when bilirubin accumulates more rapidly than the infant's liver can metabolize and expel it from the body (Mesić, I., Milas, V., Međimurec, M. and Rimar, Ž., 2014. Unconjugated pathological jaundice in newborns. Collegium antropologicum, 38(1), pp.173-178). Typically, most forms of jaundice resolve without intervention, while others may require treatment to reduce bilirubin levels.  For the best insights on the treatment of jaundice in newborns, refer to DocTube.

Signs of Jaundice in Newborns

A baby suffering from jaundice exhibits a yellowish appearance in their skin. This discoloration typically begins on the face and then spreads to the chest, stomach and eventually the legs. Additionally, the whites of the baby's eyes take on a yellowish hue. Infants with elevated bilirubin levels may display symptoms like drowsiness, irritability, limpness or difficulties with feeding (Pan, D.H. and Rivas, Y., 2017. Jaundice: newborn to age 2 months. Pediatrics in review, 38(11), pp.499-510). Detecting jaundice in newborns can be challenging, especially in babies with darker skin tones. To check, you can gently press your finger against your baby's nose or forehead. If jaundice is present, the skin will appear yellow when you lift your finger.

It is advisable to contact a doctor if your baby:

1. Starts displaying signs of illness or unusual behavior.
2. Exhibits poor feeding habits.
3. Appears unusually sleepy.
4. Experiences a worsening of jaundice symptoms.

Causes of Jaundice in Newborns

Many healthy newborns experience normal physiological jaundice. This occurs because newborns have a higher count of blood cells compared to adults. These blood cells have a shorter lifespan, resulting in increased bilirubin production when they break down. This type of jaundice typically manifests 2 to 4 days after birth and usually resolves by the time the baby reaches 2 weeks of age.

Several factors can cause jaundice in newborns, including:

1. Premature birth

Babies born prematurely have a less developed ability to process bilirubin and may require early medical intervention due to their lower tolerance for bilirubin levels.

2. Insufficient breast milk intake

In the initial weeks of life, some babies may not receive enough breast milk, either because the mother's milk production has not fully started or due to breastfeeding difficulties (Mishra, S., Agarwal, R., Deorari, A.K. and Paul, V.K., 2008. Jaundice in the newborns. The Indian Journal of Pediatrics, 75, pp.157-163). This type of jaundice, known as breastfeeding jaundice, can be mitigated by increasing feeding frequency, and lactation consultants can provide assistance.

3. Breast milk-related jaundice

In some infants, breast milk appears to slow down the liver's ability to remove bilirubin, resulting in jaundice after the first week of life. Bilirubin levels gradually improve over 3 to 12 weeks. The exact cause is not well understood and might involve a protein hindering bilirubin clearance or genetic factors, but it is typically temporary.

4. Maternal and infant blood type differences

If a baby's blood type is incompatible with the mother's, the mother's body may produce antibodies that attack the baby's red blood cells (Akgül, S., Korkmaz, A., Yiğit, S. and Yurdakök, M., 2013. Neonatal hyperbilirubinemia due to ABO incompatibility: does blood group matter. Turk J Pediatr, 55(5), pp.506-9). This can occur when the mother has blood type O, and the baby has blood type A or B or if the mother's Rh factor is negative, and the baby is Rh positive.

5. Genetic conditions affecting red blood cells

Some genetic conditions, such as hereditary spherocytosis and G6PD deficiency can make red blood cells more fragile and prone to breaking down. These are other factors that may cause jaundice in newborns. 

It is important for parents and doctors to monitor jaundice in newborns and take appropriate steps when necessary to manage and treat it.

Diagnosis of Jaundice in Newborns

Doctors can diagnose jaundice in infants by merely observing the yellowish discoloration of the skin and the whites of the eyes. Before discharging newborns from the hospital or nursing homes, all babies undergo a jaundice assessment. Babies displaying jaundice symptoms undergo a blood test to assess their bilirubin levels. Occasionally, a specialized light machine that gauges bilirubin levels in the skin is employed. However, in cases of elevated bilirubin levels, a blood test is essential to confirm the results (Mitra, S. and Rennie, J., 2017. Neonatal jaundice: aetiology, diagnosis and treatment. British Journal of Hospital Medicine, 78(12), pp.699-704). Elevated bilirubin levels can potentially result in severe complications, prompting doctors to closely monitor infants with jaundice.

Treatment of Jaundice in Newborns

The choice of treatment for jaundice in newborns is dependent on several factors, including the underlying cause of jaundice, bilirubin levels and the baby's age. Mild cases of jaundice typically resolve within 1 or 2 weeks as the baby's body naturally eliminates excess bilirubin. In instances of breastfeeding-related jaundice, mothers are advised to increase breastfeeding frequency. If the baby is not receiving enough breast milk, supplementation with formula may be recommended by the doctor. For more severe cases of jaundice in newborns, prompt treatment is essential. Treatment of jaundice in newborns usually includes the following:

1. Hydration

To prevent dehydration, fluids may be administered as elevated bilirubin levels can result from fluid loss.

2. Phototherapy

This treatment involves placing babies under specialized lights with minimal clothing to expose their skin. The light facilitates the conversion of bilirubin into a form that can be easily excreted from the body (Maisels, M.J. and McDonagh, A.F., 2008. Phototherapy for neonatal jaundice. New England Journal of Medicine, 358(9), pp.920-928). Light-therapy blankets may also be employed for this purpose.

3. Exchange Blood Transfusion

In critical situations where bilirubin levels remain excessively high despite phototherapy, an emergency procedure known as exchange blood transfusion is performed. This procedure entails replacing the baby's blood with donor blood to rapidly lower bilirubin levels.

4. Intravenous Immunoglobulin (IVIg)

Babies with blood type incompatibilities may receive IVIg through an intravenous line (Smits-Wintjens, V.E., Walther, F.J., Rath, M.E., Lindenburg, I.T., te Pas, A.B., Kramer, C.M., Oepkes, D., Brand, A. and Lopriore, E., 2011. Intravenous immunoglobulin in neonates with rhesus hemolytic disease: a randomized controlled trial. Pediatrics, 127(4), pp.680-686). IVIg functions by blocking antibodies that attack red blood cells, reducing the necessity for an exchange transfusion.

 

Can jaundice in newborns be life-threatening?

 

   

Most cases of newborn jaundice are not life-threatening. It heals as the baby’s body learns to deal with bilirubin. However, in severe cases, there may be a huge amount of bilirubin in the baby’s blood which may be harmful for his health.

 

 

What is the best homely tip to manage newborn jaundice?

 

   

The best homely tip to manage newborn jaundice is by feeding the baby frequently and ensuring adequate sunlight exposure.