Jaundice is a common condition in newborns that occurs when there is an excess of bilirubin in the blood. Bilirubin is a yellow substance produced during the normal breakdown of red blood cells. In newborns, the liver, which is responsible for processing and eliminating bilirubin, may not be fully developed. This can lead to a build-up of bilirubin in the baby’s blood, causing jaundice.
Newborn jaundice usually appears a few days after birth, and in most cases, it resolves on its own. However, it is essential for parents and caregivers to be aware of the signs, symptoms, and potential treatments for jaundice in newborns.
What Is Bilirubin and Its Role in Jaundice?
Bilirubin is a waste product formed from the breakdown of red blood cells. When red blood cells reach the end of their life cycle, the body breaks them down and recycles their components. A byproduct of this process is bilirubin, which needs to be processed by the liver and then excreted through urine and stool. In newborns, the liver may not yet be mature enough to handle bilirubin effectively, leading to a temporary buildup of this substance in the blood, which causes the skin and whites of the eyes to appear yellow.
Types of Jaundice in Newborns
There are several types of jaundice that can affect newborns, each with different causes and levels of severity.
Physiological Jaundice
This is the most common form of jaundice in newborns. It usually appears between the second and fourth day after birth and peaks around the third to fifth day. It is caused by the normal immaturity of the baby’s liver, which is unable to process and eliminate bilirubin efficiently. Physiological jaundice typically resolves on its own as the baby’s liver matures and begins to function more effectively.
Breastfeeding Jaundice
Breastfeeding jaundice occurs in some breastfed babies during the first week of life. It is often linked to insufficient milk intake, which can lead to dehydration or inadequate nutrition. These factors may result in a slower elimination of bilirubin from the body. Encouraging more frequent breastfeeding or supplementing with formula can help reduce bilirubin levels.
Breast Milk Jaundice
This type of jaundice is different from breastfeeding jaundice and occurs later, usually around the second or third week of life. It is thought to be caused by substances in the mother’s breast milk that interfere with the baby’s ability to process bilirubin. Breast milk jaundice is typically harmless and resolves without any changes to the breastfeeding routine.
Pathological Jaundice
This form of jaundice is more concerning and can indicate an underlying medical condition. Pathological jaundice appears within the first 24 hours of life or is caused by factors such as blood type incompatibility, infections, or liver disorders. Babies with pathological jaundice may need medical treatment to prevent complications.
What Does Jaundice Look Like in Newborns?
Jaundice in newborns primarily affects the skin and the whites of the eyes (sclera). The hallmark sign is a yellowish tint that spreads from the face to other parts of the body. In some cases, jaundice can also make the baby’s skin appear more pale than usual.
Yellow Skin Tone
The first visible sign of jaundice is usually a yellowish tint in the skin, especially around the face and forehead. As bilirubin levels rise, the yellowing may spread downward, affecting the chest, stomach, arms, and legs. In more severe cases, the soles of the feet and the palms of the hands may also take on a yellow hue.
Yellowing of the Whites of the Eyes
Another characteristic sign of jaundice is the yellowing of the whites of the eyes. This can be more noticeable than the skin discoloration in some newborns. The extent of eye yellowing can give healthcare providers an idea of how high bilirubin levels might be.
Changes in Urine and Stool Color
In babies with higher levels of bilirubin, urine may appear darker than usual, while stools may be lighter in color. In breastfed newborns, normal stools are usually yellow, but if a baby is jaundiced, the stool may appear pale or clay-colored.
Signs of Severe Jaundice
In severe cases of jaundice, babies may exhibit other symptoms besides skin and eye discoloration. These can include poor feeding, excessive sleepiness, irritability, or arching of the neck and back. If you notice any of these signs, it is crucial to contact a healthcare provider immediately.
How Is Jaundice Diagnosed?
Jaundice in newborns is diagnosed based on physical examination and, if needed, a bilirubin blood test. Doctors will closely monitor the baby’s skin color and may use a device called a bilirubinometer to measure the amount of bilirubin in the skin. If jaundice is suspected, a blood test may be ordered to confirm the diagnosis and determine the severity of the condition.
Routine Checkups and Assessments
Most hospitals routinely check bilirubin levels in newborns before discharge. Even after going home, it’s important for parents to keep an eye on their baby’s skin color and seek medical advice if the yellowing seems to be spreading or worsening. Routine follow-up appointments can help track the baby’s bilirubin levels and overall health.
Transcutaneous Bilirubinometry
This non-invasive test measures bilirubin levels through the skin. A small handheld device is placed against the baby’s forehead or chest, and it provides a reading of the bilirubin level. If the reading is high, a blood test may be done to confirm the results.
Blood Tests
A blood test can measure the exact amount of bilirubin in the baby’s blood. This test is often performed if the baby has significant jaundice or if the healthcare provider suspects a more serious cause. Blood tests can also help determine whether treatment is necessary.
When Is Jaundice in Newborns a Concern?
While jaundice is common and usually harmless, there are times when it can become a cause for concern. The timing, duration, and severity of jaundice are important factors in determining whether medical intervention is required.
Jaundice Within the First 24 Hours
If jaundice appears within the first day of life, it is considered a red flag. This early onset of jaundice could indicate a more serious underlying issue, such as hemolytic disease of the newborn (HDN), a condition where the baby’s red blood cells are broken down more rapidly than normal.
Prolonged Jaundice
Jaundice that persists for more than two to three weeks may also be concerning. Prolonged jaundice could be a sign of a more serious condition, such as liver disease or a metabolic disorder. Babies with prolonged jaundice may require additional tests to identify the cause.
High Bilirubin Levels
High levels of bilirubin can lead to complications such as kernicterus, a rare but serious form of brain damage caused by excessive bilirubin crossing into the brain. Kernicterus can lead to permanent neurological damage, including hearing loss, vision problems, and cognitive impairment. Signs of dangerously high bilirubin levels include extreme lethargy, poor feeding, and abnormal muscle tone.
SEE ALSO: How Do Infants Get Jaundice?
Treatment Options for Jaundice in Newborns
Most cases of newborn jaundice do not require treatment and resolve on their own as the baby’s liver matures. However, in cases where bilirubin levels are higher than normal or if jaundice persists, treatment may be necessary.
Phototherapy
Phototherapy is the most common treatment for jaundice. During phototherapy, the baby is placed under special blue lights that help break down bilirubin in the skin. This process makes it easier for the baby’s body to eliminate bilirubin through urine and stool. Phototherapy is usually done in the hospital, but in some cases, home phototherapy may be an option.
Exchange Transfusion
In severe cases of jaundice, an exchange transfusion may be needed. This procedure involves replacing some of the baby’s blood with donor blood to rapidly reduce bilirubin levels. Exchange transfusions are rare and are only used when bilirubin levels are dangerously high and other treatments have not been effective.
Increased Feeding
For mild cases of jaundice, increasing the frequency of feedings can help the baby eliminate bilirubin more efficiently. Breastfeeding or bottle-feeding more frequently encourages the baby to produce more wet diapers and bowel movements, helping to clear bilirubin from the body.
Preventing Jaundice in Newborns
While it is not always possible to prevent jaundice, there are steps parents can take to reduce the likelihood of severe jaundice developing.
Ensure Adequate Feeding
One of the most important ways to prevent jaundice is by ensuring that the baby is feeding well. Frequent feeding helps to promote bowel movements, which are essential for eliminating bilirubin from the body. Breastfed newborns should be nursed at least eight to twelve times per day in the first few days of life.
Monitor for Signs of Jaundice
Parents should be vigilant in monitoring their newborn for signs of jaundice, especially in the first few days after birth. If jaundice appears to be worsening or spreading to other parts of the body, it is important to seek medical advice.
Conclusion
In summary, jaundice in newborns is a common and usually harmless condition caused by elevated bilirubin levels in the blood. It often manifests as a yellowish tint in the skin and eyes and typically resolves on its own as the baby’s liver matures. However, in some cases, jaundice may require medical attention, especially if it appears within the first 24 hours of life or lasts beyond two to three weeks. Early detection, monitoring, and proper care, such as increased feeding or phototherapy, are essential for managing jaundice effectively and ensuring the newborn’s health.
