Neonatal jaundice: know when the disease is severe

After the birth of a baby, the main concern of the family and also of the medical team is to ensure that it is healthy and that it will be able to develop normally.

Thus, the first 24 hours are crucial for the newborn, who is observed at all times and examined to ensure that everything is fine.

During this period, some children may experience changes that are considered common, as they affect most newborns, or others that are a little more worrisome and require treatment.

In this text, we will address one of these changes, neonatal jaundice, which although it is common, can compromise the baby’s health.

What is neonatal jaundice?

Neonatal jaundice, also known as yellowing, is a problem that causes the mucous membranes, eyes and skin of newborns to turn yellow. In general, the condition is considered common and in most cases it is not serious.

The “yellowing” occurs due to the increase in the rate of bilirubin in the bloodstream. This substance is found in bile and remains in the body until it is eliminated in the urine (hence the yellow color of the urine).

Jaundice usually appears after the baby’s first 24 hours of life and disappears between the first and second weeks after birth. Among the main reasons for this is the very immaturity of the baby’s organism. But as the days go by, most conditions resolve spontaneously, without the need for treatment.

However, in some cases, it can worsen and cause complications, so pediatric monitoring is essential.

When specialists believe that the condition is dangerous or will not pass alone, the most indicated treatments are usually phototherapy (exposing the child to special lights), and exsanguineotransfusion (in more severe cases of jaundice).

What is bilirubin?

Bilirubin is produced by the body, which is yellowish in color, and can lead to pigmentation of the skin, eyes and mucous membranes (called jaundice). The substance is formed due to the destruction of red blood cells, also called red blood cells, which are blood cells responsible for transporting oxygen to the body.

One of the factors that makes neonatal jaundice common is the life span of the cells. In an adult person, it is usually 120 days, whereas in newborns, the time varies between 77 to 98 days.

Since bilirubin results from the destruction of cells, the faster they die, the greater the concentration of the substance in the body.

Another aggravating factor is that in order for the substance to be metabolized and eliminated, it is necessary that it undergoes a long journey, but that it can present flaws (which is very normal in newborns). Thus, bilirubin builds up in the baby’s bloodstream.

What is the role of bilirubin in jaundice?

Bilirubin directly influences the appearance of neonatal jaundice, because when it is in excess in the newborn’s body, it ends up being deposited on the child’s skin.

In general, this is due to something interfering with the substance’s metabolization process, causing it to become inadequate or incomplete.

What are the causes?

The main reason for the baby’s skin, mucosa and eyes with neonatal jaundice to turn yellow is the increase in bilirubin.

In general, the main cause of neonatal jaundice is the accumulation of bilirubin in the bloodstream, characterizing a picture of hyperbilirubinemia.

This accumulation can occur in two ways: by the excessive production of the substance or by the inability to eliminate it.

Thus, some treatments can be initiated so that the baby has the appropriate level of bilirubin in the bloodstream, which is between 0.2mL to 1.1mL.

This result is the sum of the two types of bilirubin that are in the child’s body, direct bilirubin (also called conjugate) and indirect (unconjugated), that is, the one that was metabolized by the liver and the one that was not.

What factors can cause neonatal jaundice?

The newborn may have neonatal jaundice due to a number of reasons, such as hereditary diseases, difficulties in the metabolization of different substances, infections, among others.

However, there are some factors that influence and increase the baby’s chances of developing jaundice, they are:

Premature birth

A baby is considered premature when its birth occurs before the normal gestation period, which is 37 weeks.

In this case, it is expected that the newborn will present the disease, as the liver (as well as other organs) is not developed enough to be able to metabolize bilirubin.

Blood incompatibility

Blood incompatibility occurs when the fetus carries the RH (positive) agent while the mother is RH negative.

This causes, during pregnancy, the mother’s organism to produce antibodies to destroy the RH agent in the baby’s red blood cells, as he understands that the RH is an invader.

In order to convert the hemoglobin present in the erythrocytes that were destroyed, bilirubin is produced in large quantities, causing the “yellowing”.

The mother already had an incomparable child

When there is blood incompatibility in the first pregnancy, the antibodies produced against the RH agent remain in the bloodstream, ready to fight the “invader” again.

Therefore, in the case of a second pregnancy (the fetus has a different HR from the mother), the baby has a greater chance of developing neonatal jaundice.

Mother with diabetes or gestational diabetes

Children of mothers who have diabetes or develop it during pregnancy (if not controlled) are at increased risk of having neonatal jaundice.

It is believed that high blood glucose levels during pregnancy trigger changes in the production of red blood cells, that is, there is an increase in the production of red cells by the baby.

After birth, the body begins to destroy this surplus, causing more bilirubin to be released.

Breastfeeding

Although the specific reason is not yet known, breastfeeding can cause jaundice or prolong the duration of the illness in the baby.

Experts believe it may be due to the chemical properties of milk or the lack of milk provided by the mother to the baby.

Therefore, it is necessary to observe the newborn and the physiological responses he gives after being breastfed.

If your skin and mucous membranes start to turn yellow or your stools become whitish or too yellow, it should be taken to the pediatrician as soon as possible.

How is neonatal jaundice diagnosed?

The diagnosis of neonatal jaundice occurs through physical examinations, research and laboratory tests that identify the rate of bilirubin present in the baby’s blood and the possible origin of the disease.

Among these modes of diagnosis the most common are:

  • Physical exams: digital pressure on the baby’s forehead, if he has jaundice the skin will turn yellow after pressure;
  • Research: about the child’s prematurity, his weight and height, and other diseases that the child has.
  • Laboratory: blood test to check the rate of bilirubin in the circulation.

When is neonatal jaundice of concern?

Neonatal jaundice is of concern when it is not considered physiological, that is, due to other diseases or abnormalities. Understand the differences better:

Physiological jaundice

To be considered physiological, the disease must appear between 48 and 73 hours after birth, that is, from the child’s 3rd day of life and should not last more than 2 weeks.

When jaundice is considered to be physiological, the risks to the baby’s health are less, as the condition is reversible.

Probably the disease was triggered due to irregularities in the hepatic circulation (liver), which end up causing changes in the production or elimination of bilirubin.

Pathological jaundice

Pathological jaundice appears in the first 24 hours of a baby’s life and the level of bilirubin in the blood tends to rise very quickly.

Unlike physiological jaundice, the pathological does not disappear in a few weeks, being necessary in addition to common treatments such as phototherapy and exsanguineotransfusion, others that are able to inhibit the origin of the jaundice.

What can jaundice cause in the baby?

If it is not diagnosed and treated in time, pathological neonatal jaundice can evolve and impair the child’s development.

The most severe complication that occurs due to jaundice due to pathological issues is kernicterus.

The condition is characterized by the level of bilirubin in the bloodstream above 25mg / dL (milligrams per deciliter) and the appearance of symptoms such as drowsiness, poor appetite and low toning of the baby’s muscle tissue.

In addition to these symptoms, others may appear over the months if the bilirubin rate does not decrease, such as:

  • Spasms;
  • Frequent crying attacks;
  • Vomiting;
  • Fever.

If the diagnosis is not made, kernicterus may prevent the baby from being able to crawl, sit and walk properly in the future. The child may also have difficulties with hearing, vision and mental retardation.

Thus, it is extremely important to take the newborn to the pediatrician for the diagnosis to be made and, consequently, the treatment started, as this is the only way to avoid the condition of kernicterus.

How to treat neonatal jaundice?

Phototherapy is one of the forms of treatment used for neonatal jaundice.

In general, when jaundice is classified as physiological, it is expected that it will disappear with the passing of days, without the need for specialized treatments, as it is an adaptation of the child’s organism.

However, when the case is more serious and is characterized as pathological, treatments such as phototherapy and exsanguineotransfusion may be prescribed.

They work as follows:

Phototherapy

Phototherapy is a form of treatment that consists of exposing the baby to the special lights that affect the pigment structure (bilirubin). This is so that it is destroyed and the baby can eliminate it through urine.

To perform phototherapy, a blindfold is placed under the baby’s eyes so that the lights do not damage his vision, then he is placed in a cradle, under lamps that are between 30cm and 50cm from his skin. There, it remains for the time defined by the pediatrician.

In general, phototherapy treatment is prescribed for a few days, however, everything will depend on how high the bilirubin levels are in the child’s body.

Blood transfusion

Exsanguineotransfusion is a medical procedure that consists of replacing the baby’s blood with another that is compatible with your body.

For the treatment to be efficient, blood that will be used must consist of red blood cells collected less than 7 days ago and the plasma that constitutes it must be frozen.

It is possible to guarantee that blood is in these conditions by means of a laboratory test (hematocrit) that ensures the amount of red blood cells present, the result must be 45% to 50% for the transfusion to occur.

The entire procedure must be done at a specialized medical center to avoid complications.

Can you avoid it?

The best way to avoid neonatal jaundice is to follow the guidelines during prenatal care.

Yes, neonatal jaundice can be avoided, especially during prenatal care.

During this follow-up period, several tests and treatments can be done in order to ensure the baby’s development during pregnancy and also to decrease the child’s chances of having jaundice.

Like, for example, the application of a special vaccine (anti-RH immunoglobulin) for mothers who had blood incompatibility with the baby.

It prevents the antibodies present in the woman’s body from fighting the RH agent present in the fetus. In general, one dose is required at the 28th week of gestation and another up to 72 hours after the child’s birth.

In addition, following pediatric recommendations after the baby is born, in relation to breastfeeding, sunbathing, vaccines, among others, is essential so that the newborn does not present the disease (at least not in a serious way).


Health care is important in all stages of life, especially in the first months, since newborns are fragile and need care so that they can develop in an appropriate and healthy way.

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