What is newborn jaundice?
Newborn jaundice is medically known as neonatal hyperbilirubinemia. It develops in about 60% of full-term and 80% of preterm infants in the first week after birth. It occurs because the infant’s liver is unable to process the increased amount of bilirubin that is formed during the breakdown of red blood cells.
Since bilirubin is yellow, parents observe a characteristic coloration of the baby’s skin, scleras, and mucous membranes. Mostly, this is a mild condition – physiological jaundice, which does not require any treatment.
In fact, bilirubin is an antioxidant that can help fight infection in newborns. So, there is no need to worry too much.
However, sometimes pathological jaundice develops, a dangerous disorder that can lead to serious complications and even death.
Physiologic jaundice occurs approximately 24–36 hours after birth, reaches its peak at 48–96 hours, and disappears within two to three weeks.
Pathological jaundice appears on the first day of life. Although, this is only 5% of all cases.
In any case, if you notice signs of jaundice in your baby, consult a pediatrician to rule out a severe form.
Why does jaundice occur?
Elevated bilirubin levels are normal after birth. Usually, physiologic jaundice occurs for two reasons:
Breastfeeding jaundice. It occurs in the first week after birth because the baby does not eat enough. This may be because he is not latching on properly or there is not enough milk. Milk helps to eliminate bilirubin and cleanse the body of other waste products, so it is important to establish a good feeding pattern.
Jaundice from breast milk. It usually develops after the first week of life. During the second or third week, the bilirubin level reaches its maximum, then slowly decreases and disappears in a month or so. The reasons why breast milk causes this reaction are not yet known. However, the benefits of breastfeeding definitely far outweigh the risks of this type of jaundice.
Risk factors
Severe jaundice is caused by factors related to an increase in red blood cell count and difficulty in eliminating bilirubin. That includes:
- Bacterial or viral infections;
- Mismatch of the blood type of the mother and child or Rh incompatibility;
- Deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), which can lead to red blood cell breakdown;
- Gilbert syndrome or Crigler-Najjar syndrome, which lead to problems with an enzyme that is needed to get rid of bilirubin;
- Hemorrhage in the body or under the scalp (cephalohematoma) due to difficult delivery. It leads to significant destruction of red blood cells;
- Problems with liver function complicate the process of bilirubin excretion;
- Reduced thyroid function (hypothyroidism). The thyroid gland does not produce enough hormones that affect not only the metabolism of bilirubin, but also play a crucial role in the development of the child;
- Diseases that affect the liver or biliary tract, such as cystic fibrosis or hepatitis;
- Genetic factors. If one child in the family has jaundice, future children may also be at higher risk. For example, babies of East Asian descent are more likely to have higher bilirubin levels.
Symptoms
The main symptom is the yellow color of the newborn’s skin, as well as the whites of his eyes and mouth. It starts with the head, and as the bilirubin level rises, the yellow coloration moves to the chest, abdomen, and eventually the legs.
It is important not to miss the signs of severe jaundice, which include:
- Poor appetite and dry diapers (there should be at least six wet diapers per day);
- Urine is dark yellow or brown;
- Discolored feces;
- The child is lethargic and difficult to wake up;
- The baby is constantly crying or screaming;
- The baby stiffens or arches its back;
- Muscles become extremely soft;
- Strange eye movements.
The correct algorithm is following: parents consult a pediatrician about jaundice at the first sign. Then parents observe the child, and if the above symptoms appear, they contact the doctor for further instructions.
Complications
Physiologic jaundice does not cause any complications. Thus, pathological jaundice, if left untreated, can be severe and long-lasting. Very rarely – even fatal.
If left untreated, complicated jaundice can lead to a condition called bilirubin encephalopathy, or kernicterus. This is an extremely dangerous but very rare condition that occurs in 0.001-0.002% of newborns. Kernicterus can lead to the following pathologies:
- Infantile cerebral palsy;
- Hearing loss;
- Developmental delays;
- Problems with vision;
- Underdevelopment of teeth;
- Seizures.
Although extremely rare, pathological jaundice can lead to the death of a baby. According to statistics, this is 0.12% of cases in low-income countries and 0.001% in high-income countries.
At the same time, even these dangerous and incurable complications can be prevented if you are attentive to your child. And do not ignore the previous symptoms.
How is newborn jaundice treated?
Physiologic jaundice does not require treatment. Medical help is needed only if the bilirubin level is too high or rising rapidly. It is then that parents observe the symptoms of pathological jaundice mentioned above.
The first method that doctors will suggest is frequent breastfeeding – up to 12 times a day. This will help the baby to excrete bilirubin in the stool faster. It is best if it is breast milk, but if it is not available, infant formula is also ok.
Medical procedures
Preventing the development of complications, especially bilirubin encephalopathy:
Phototherapy. The baby is placed under a special light (or wrapped in a special blanket with light emitters inside), which helps the body get rid of bilirubin. The procedure is effective and has almost no contraindications. During phototherapy, you can take short breaks for feeding.
Exchange blood transfusion. Used when the bilirubin level is extremely high and there is a threat of brain damage. The procedure requires a healthy donor with the same blood type.
Intravenous immunoglobulin. Prescribed in case of Rh incompatible jaundice, but only after phototherapy has failed.
And of course, if the jaundice is caused by an infection, it needs to be treated.
If you have any questions about your baby’s health, you can contact the Lior Medical Center.
You can learn more about the first year of a child’s life after birth in the program Postpartum period up to 1 year of life. And everything you need to know about pregnancy and the first year of a newborn’s life is contained in my course Pregnancy and Postpartum – A Complete Guide.
I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com.
