Jaundice in newborns: causes and treatment


What is neonatal jaundice?

Neonatal jaundice is a term that indicates that the child’s skin and its sclera (the white part in the eye) are yellow or yellowish in color.

If jaundice occurs in adults, it means that the person has a disease.
Jaundice is caused by the accumulation of a substance called bilirubin in the blood.
Neonatal jaundice is very common, with about 3 out of 5 children (60 percent) suffering from it.
These signs usually appear a few days after birth.

In most cases, it is mild, does not cause discomfort to the child and passes again without therapy. However, if the child has high-grade jaundice and is not treated immediately, this can lead to cerebral damage.

Causes of neonatal jaundice

It is normal for a newborn’s bilirubin level to be slightly elevated after birth.
As the child grows in the uterus, the placenta removes the bilirubin from the child’s body.
The placenta is an organ that develops during pregnancy to nourish the child.
After birth, the child’s liver begins to take over this work. However, this may not yet be sufficiently developed to perform this function correctly and this may take some time.
Most newborns have more or less mild jaundice.
It is also called “physiological jaundice”.
It is harmless and usually worst when the child is 2-4 days old. As a rule, it passes within 2 weeks and does not cause any further disturbances.

Types of jaundice in newborns

Jaundice in premature infants: It often occurs in newborns who are not yet able to successfully excrete bilirubin. Jaundice in premature babies must be adjusted to lower bilirubin levels compared to babies born on time to avoid complications.

Jaundice during lactation: Jaundice caused by breastfeeding occurs in the first week in children who are breastfed.
Jaundice can occur during lactation because the child has difficulty eating or because there is not yet enough milk in the breast.
This is not caused by a disturbance in breast milk, but by the fact that the child does not drink enough.

Milk-associated jaundice: In 1-2% of breastfed infants, jaundice may be caused by substances produced in breast milk that lead to an increase in bilirubin levels.
These substances can prevent the excretion of bilirubin through the intestine. This starts after the first 3-5 days and gradually improves within 3-12 weeks.

Blood type intolerance (Rh or ABO): If a child has a different blood type than the mother, she could develop antibodies that destroy the newborn’s red blood cells.
This leads to sudden accumulation of bilirubin in the child’s blood.
Jaundice due to incompatibility can begin on the first day of life.
In the past, problems with Rh factor led to severe forms of jaundice, but now this can be prevented by injecting Rh immunoglobulins via the mother within 72 hours of birth.
Infiltration prevents the formation of antibodies that could affect future pregnancies.

Disease-related neonatal jaundice

All causes of jaundice are considered disease-related, apart from physiological jaundice, jaundice caused by breastfeeding or breast milk.
Disease-related jaundice has the following characteristics:

  • appearance of yellowing of the skin within 24 hours after birth,
  • rapid increase in total blood bilirubin levels (more than 5 mg/dl per day),
  • The value of total serum bilirubin is higher than 17 mg/d in a baby born on time.

Other non-negligible features are:

  • long-lasting jaundice,
  • diagnosis of a disease,
  • Conjugated bilirubin levels higher than 2 mg/dl or higher than 20% of total blood bilirubin.

Causes of disease-related neonatal jaundice

Kephal hematoma (bruise in the skull)
In some cases, the baby may suffer trauma to the head during the birth process, as a result of which a hematoma forms in the skull.
Since this blood is absorbed naturally, there is a sudden increase in bilirubin in the blood, the not yet fully developed liver of the newborn may not be able to process this amount of bilirubin.

Enzymatic deficit of red blood cells

  • Deficiency of glucose-6-phosphate dehydrogenase (G6PD), which protects red blood cells from oxidation.
  • Deficiency of pyruvate kinase (enzyme involved in glycolysis), which can lead to an increase in hemolysis and thus bilirubin levels.

Abnormalities of the membrane of red blood cells
Spherocytosis (spherical, more fragile and less deformable red blood cells) can lead to increased destruction of red blood cells.

Other possible causes of neonatal jaundice:

  • Premature birth
  • Mother is diabetic
  • Polycythemia (increase in red blood cells)
  • Infection/Sepsis
  • Hypothyroidism
  • Bile duct atresia (occlusion of the bile ducts)
  • Cystic fibrosis
  • Crigler-Najjar syndrome
  • Gilbert’s syndrome
  • Hepatitis
  • Thalassemia (form of anaemia)
  • Galactosemia (disturbance of glactose metabolism)

Symptoms of neonatal and adult jaundice

Typically, symptoms appear between the second and fourth day after birth and include:

  • Yellowing of the skin
  • Yellowing of the eyes

Jaundice is usually first noticed on the child’s face. As the disease progresses, the yellow color can be seen in the eyes and on the chest, abdomen, arms and legs.
The best way to detect jaundice in the child is to lightly press your finger on the child’s forehead or nose. If the skin appears yellow at the pressure point, the child is likely to have jaundice.
If the child does not have jaundice, the skin color should appear slightly lighter than normal for a short moment.
The child should be examined in good lighting, preferably in daylight.

When is there cause for concern? When is a doctor’s visit recommended?

  • If the child makes a sick impression: he does not eat, is very tired or has a fever.
  • When the yellowing worsens instead of improving.
  • When jaundice spreads from the face to the rest of the body.
  • If the jaundice lasts more than 20 days.
  • If the newborn does not gain weight or inadequately feeds.
  • If the child’s stool has a light tint, and the urine has a dark tint.

Possible complication of neonatal jaundice

  1. Encephalopathy caused by jaundice
    A disease provoked by the accumulation of bilirubin in the brain.
    Bilirubin is toxic to brain cells.
    The symptoms are: fever, tiredness, crying, refusal of food, overextension of the neck and spine.
  2. Kernicterus
    A potentially fatal syndrome that occurs when bilirubin encephalopathy causes permanent damage to the brain, athetoid cerebral palsy, mental retardation, apathy, hypotension, and loss of neonatal reflexes.

Diagnosis of neonatal jaundice

Before leaving the hospital with the newborn, one can ask the doctor about bilirubin tests for jaundice.
The doctor can measure the bilirubin in the child by using a light meter aimed at the child’s head.
This examination indicates the value of transcutaneous bilirubin. If this is high, the doctor may order a blood test. The best way to accurately measure bilirubin is to examine a small sample of blood from the child’s heel.

Here, the total bilirubin in the serum is indicated (BILTS).
If the level is high due to the age of the child measured in hours and other risk factors, therapy may be required. Repeated blood tests ensure that BILTS decreases under the prescribed treatment.
Bilirubin levels are usually highest when the child is 3-5 days old. It is necessary to check every 48-8 hours for the first 12 hours, and then for the first 5 days of life, whether the child has jaundice.

What is the therapy for neonatal and adult jaundice?

Most newborns with jaundice do not require any therapy.
As a rule, jaundice passes within 2 weeks in bottle children. It can last longer than 2 or 3 weeks in children who are breastfed. If jaundice in children lasts longer than 3 weeks, you should talk to the doctor.

If the child has severe jaundice, one of the following treatments may be required:

Treatment by phototherapy (also called light therapy). This is done by exposing the child to a special lamp that leads to the decomposition of bilirubin in the body, which is then excreted in the urine.
While the newborn lies under the light, he is allowed to wear only a diaper and special glasses.
Some children can lie on a light mat (so-called fiber optic illuminated mat), which has small lights inside.
Use the mat instead of the lamp or use both together. Phototherapy can be done in the hospital or at home and is safe for the child.

Blood transfusion. If phototherapy is ineffective and the child’s bilirubin levels are still too high, a special type of blood transfusion called an exchange transfusion may be required. Exchange transfusion makes it possible to eliminate bilirubin by replacing the child’s blood with fresh blood in small quantities.

Intravenous immunoglobulins (also called IVIG). If the mother and child have different blood types, the doctor may decide to inject immunoglobulins (blood proteins) intravenously into the child. This can help treat jaundice, reducing the need for an exchange transfusion.

How long does neonatal jaundice last? Prognosis, consequences and recovery times

Neonatal jaundice is usually neither severe nor fatal.
In most children, jaundice improves within 1-2 weeks without therapy.
A greatly increased bilirubin level can damage the brain.
This is called kernicterus, bilirubin encephalopathy, or nuclear jaundice. However, this condition is almost always diagnosed before levels rise too high to cause such damage.
For children who need treatment, therapy is generally effective.

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