Jaundice is a common condition in newborns, affecting nearly 60% of full-term babies and even more premature infants. It is characterized by the yellowing of the skin and the whites of the eyes due to high levels of bilirubin in the blood. While jaundice is usually harmless and resolves on its own, understanding its causes, types, and treatment is crucial for ensuring the health and well-being of the infant.
What is Bilirubin?
Bilirubin is a yellow pigment produced during the normal breakdown of red blood cells. It is processed by the liver, which then eliminates it from the body through stool. However, in newborns, the liver is often not mature enough to handle the high levels of bilirubin produced, leading to its accumulation in the blood and causing jaundice.
How Bilirubin is Processed in the Body
Breakdown of Red Blood Cells: Red blood cells break down naturally in the body, releasing hemoglobin.
Conversion to Bilirubin: The hemoglobin is converted into bilirubin, which circulates in the bloodstream.
Liver Processing: The liver takes up bilirubin from the blood and processes it into a form that can be excreted.
Excretion: Bilirubin is excreted from the body through bile, which leaves the body in stool.
In newborns, the process is less efficient, especially in the first few days of life, which can lead to the build-up of bilirubin and the development of jaundice.
Causes of Jaundice in Infants
There are several causes of jaundice in infants, ranging from normal physiological processes to more serious health conditions.
Physiological Jaundice
Physiological jaundice is the most common type of jaundice in newborns. It usually appears 2-4 days after birth and resolves within 1-2 weeks. This type of jaundice is considered normal and is due to the immature liver not being able to process bilirubin as efficiently as needed.
Breastfeeding Jaundice
Breastfeeding jaundice occurs in the first week of life and is often associated with breastfeeding difficulties. When a baby is not feeding well, they may not get enough breast milk, leading to dehydration and decreased bowel movements, which in turn reduces the excretion of bilirubin.
Breast Milk Jaundice
Breast milk jaundice typically appears after the first week of life and can last for several weeks. It is thought to be caused by substances in breast milk that may increase the reabsorption of bilirubin from the intestines.
Hemolytic Disease
Hemolytic disease of the newborn, such as Rh or ABO incompatibility, can cause jaundice. This occurs when the mother’s immune system produces antibodies that attack the baby’s red blood cells, leading to an increased breakdown of these cells and, consequently, a rise in bilirubin levels.
Premature Birth
Premature babies are at higher risk for jaundice because their livers are even less developed than those of full-term babies. They may also have a higher turnover of red blood cells, contributing to higher bilirubin levels.
Infections and Other Medical Conditions
Infections like sepsis or urinary tract infections, and other medical conditions such as hypothyroidism or genetic disorders, can also lead to jaundice in newborns. These conditions can affect the liver’s ability to process bilirubin or increase the breakdown of red blood cells.
Symptoms and Diagnosis of Jaundice
Symptoms to Watch For
The primary symptom of jaundice is the yellowing of the skin and the whites of the eyes. This yellowing typically starts on the face and then spreads to the chest, abdomen, and legs as bilirubin levels rise.
Other symptoms may include:
Poor feeding or difficulty waking
Irritability
Dark urine (in contrast to the typical light-colored urine of newborns)
Pale-colored stool
How Jaundice is Diagnosed
Jaundice is usually diagnosed through a physical examination by a healthcare provider. If jaundice is suspected, the following tests may be conducted:
Bilirubin Level Test: A blood test or a non-invasive transcutaneous bilirubinometer can measure the bilirubin levels in the baby’s blood.
Blood Tests: Additional blood tests may be done to determine the cause of jaundice, such as checking for blood type incompatibility, infection, or other underlying conditions.
Treatment of Infant Jaundice
Phototherapy
Phototherapy is the most common treatment for jaundice. It involves placing the baby under special lights that help break down bilirubin in the skin. The baby’s eyes are covered to protect them from the lights, and the treatment continues until bilirubin levels drop to a safe range.
Exchange Transfusion
In severe cases of jaundice, an exchange transfusion may be necessary. This procedure involves replacing the baby’s blood with fresh blood to quickly lower bilirubin levels. This is typically only done in cases where there is a risk of bilirubin reaching levels that could cause brain damage.
Intravenous Immunoglobulin (IVIG)
If jaundice is due to blood type incompatibility, IVIG treatment might be used. IVIG helps reduce the levels of antibodies that are attacking the baby’s red blood cells, thereby lowering bilirubin levels.
Feeding and Hydration
Ensuring that the baby is feeding well and staying hydrated is crucial. Frequent breastfeeding helps increase the baby’s bowel movements, which in turn helps eliminate bilirubin. In some cases, supplemental feeding with formula may be recommended to ensure the baby is getting enough fluids.
SEE ALSO: How Long Does Mild Jaundice Last in Newborns?
Complications of Untreated Jaundice
Kernicterus
One of the most serious complications of untreated jaundice is kernicterus, a form of brain damage that can occur if very high levels of bilirubin are not treated. Kernicterus can lead to long-term neurological issues, including hearing loss, vision problems, and intellectual disabilities.
Acute Bilirubin Encephalopathy
Before kernicterus develops, a baby may experience acute bilirubin encephalopathy, which is a sign that bilirubin is affecting the brain. Symptoms include lethargy, poor feeding, high-pitched crying, and arching of the body. This condition requires immediate medical attention.
Preventing Infant Jaundice
Regular Feeding
One of the best ways to prevent jaundice is to ensure that the baby is feeding regularly. This helps promote regular bowel movements, which aids in the excretion of bilirubin.
Monitoring by Healthcare Providers
Newborns should be monitored closely by healthcare providers for signs of jaundice, especially in the first week of life. If jaundice is detected early, it can often be managed before it becomes severe.
Managing Risk Factors
If a baby is at higher risk for jaundice (such as being born prematurely or having a blood type incompatibility), extra precautions may be taken, such as earlier and more frequent bilirubin level checks.
Conclusion
Jaundice is a common condition in newborns that usually resolves on its own without causing harm. However, understanding the causes, symptoms, and treatments of jaundice is essential for parents and caregivers to ensure the health and safety of the infant. By recognizing the signs early and seeking appropriate medical care, serious complications can be prevented, allowing the baby to thrive.
