Jaundice is a common condition in newborns, occurring in about 60% of term babies and up to 80% of premature infants. It is characterized by the yellowing of the skin and eyes, caused by an excess of bilirubin in the blood. Bilirubin is a byproduct of the breakdown of red blood cells, and newborns often have higher levels due to their immature liver, which is not fully efficient at processing and eliminating it.
In most cases, jaundice is mild and resolves on its own without treatment. However, in some situations, jaundice may become more severe and require medical intervention. One of the most common treatments for severe jaundice is phototherapy.
This article will explore the circumstances under which phototherapy is needed for jaundice, including the causes of jaundice, how it is diagnosed, and when it becomes severe enough to require treatment.
What Causes Jaundice in Newborns?
Jaundice occurs when bilirubin builds up faster than the liver can break it down and eliminate it from the body. This condition is most often caused by the normal breakdown of red blood cells in newborns. Several factors can contribute to the development of jaundice, including:
Physiological Jaundice:
The most common type of jaundice in newborns, physiological jaundice, occurs due to the normal breakdown of fetal red blood cells after birth. The liver of a newborn is still immature and may not be able to process bilirubin efficiently, leading to a buildup in the blood. This type of jaundice usually appears on the second or third day of life and resolves within two weeks.
Breastfeeding Jaundice:
Breastfeeding jaundice occurs in breastfed babies, usually due to dehydration or poor feeding during the first week of life. If a newborn is not getting enough breast milk, it may lead to dehydration, which can slow down the removal of bilirubin from the body.
Breast Milk Jaundice:
This form of jaundice typically appears after the first week of life and may persist for several weeks. It is thought to be caused by certain substances in breast milk that interfere with the liver’s ability to process bilirubin. Breast milk jaundice is usually mild and does not require treatment, but it may last longer than other forms of jaundice.
Hemolytic Jaundice:
Hemolytic jaundice occurs when there is an abnormal breakdown of red blood cells, which can happen due to conditions like blood type incompatibility between the mother and baby (such as Rh or ABO incompatibility) or other blood disorders. This form of jaundice can lead to very high levels of bilirubin and may require prompt treatment to prevent complications.
Premature Birth:
Babies born prematurely are more likely to develop jaundice because their livers are even less mature than those of full-term babies. Premature infants may take longer to process and eliminate bilirubin from their bodies.
Other Causes:
In rare cases, jaundice can be caused by infections, liver problems, or genetic conditions that affect the breakdown of red blood cells.
How is Jaundice Diagnosed?
The diagnosis of jaundice typically involves a physical examination and testing of bilirubin levels. The yellowing of the skin and eyes is usually a visible sign that prompts further evaluation.
Visual Examination:
The doctor will look at the baby’s skin and the whites of the eyes to assess the level of yellowing. In mild cases of jaundice, the yellowing may only be present on the face, while in more severe cases, it may spread to the chest, arms, legs, and even the palms and soles.
Bilirubin Level Testing:
To determine the severity of jaundice, a blood test or a non-invasive test using a bilirubin meter (which measures the level of bilirubin in the skin) may be performed. Bilirubin levels are measured in milligrams per deciliter (mg/dL), and the doctor will use these measurements to determine whether treatment is necessary.
Blood Tests:
In some cases, additional blood tests may be needed to identify the cause of jaundice, especially if the baby has hemolytic jaundice or another underlying condition.
When Does Jaundice Require Phototherapy?
Phototherapy is one of the most effective treatments for jaundice. It involves exposing the baby’s skin to a special type of light that helps break down bilirubin into a form that can be more easily eliminated by the body.
The decision to start phototherapy depends on several factors, including the baby’s age, bilirubin levels, gestational age, and overall health. In most cases, phototherapy is recommended when bilirubin levels reach a certain threshold that poses a risk for complications.
Threshold for Phototherapy in Jaundice Treatment
The critical levels of bilirubin that require phototherapy depend on the following factors:
Age in Hours: Bilirubin levels are compared to the baby’s age in hours. For example, a newborn who is 24 hours old may have a different threshold for treatment compared to a baby who is 72 hours old.
Gestational Age: Premature babies have lower thresholds for phototherapy because they are at higher risk for complications from high bilirubin levels. For instance, a preterm baby may require phototherapy at a lower bilirubin level than a full-term baby.
Risk Factors: Babies with certain risk factors, such as hemolytic jaundice or other underlying medical conditions, may need phototherapy even at lower bilirubin levels.
Here are some general guidelines for when phototherapy is recommended:
Term Babies (37 weeks or more): Phototherapy is typically recommended when bilirubin levels reach 15 mg/dL to 20 mg/dL, depending on the baby’s age in hours and the presence of other risk factors.
Preterm Babies (less than 37 weeks): The threshold for phototherapy is lower, typically starting at around 10 mg/dL to 15 mg/dL, due to the increased risk of complications in preterm infants.
Risk Factor Considerations: Babies with risk factors like hemolytic jaundice, significant bruising, or dehydration may require phototherapy at lower bilirubin levels, sometimes as low as 10 mg/dL.
How Does Phototherapy Work?
Phototherapy works by using light to change the structure of bilirubin, making it easier for the baby’s liver to eliminate it from the body. This light therapy can be delivered in various ways:
Conventional Phototherapy:
This involves placing the baby under a blue light source, typically in a hospital setting. The baby’s eyes are covered for protection, and the baby is usually placed naked or with minimal clothing to maximize skin exposure to the light.
Fiber-optic Phototherapy:
In this method, a light-emitting pad or blanket is placed directly on the baby’s skin. This allows for more mobility and can sometimes be used at home, depending on the severity of jaundice.
LED Phototherapy:
LED lights are used in modern phototherapy units, as they are more energy-efficient and provide a specific wavelength of light that is most effective in breaking down bilirubin.
How Long Does Phototherapy Last?
The duration of phototherapy depends on how quickly the bilirubin levels decrease. In most cases, phototherapy is continued until bilirubin levels drop to a safe range. This process may take a few hours to a few days, depending on the severity of jaundice and the baby’s response to treatment.
The baby’s bilirubin levels will be monitored regularly throughout treatment, either through blood tests or a bilirubin meter. Once bilirubin levels have stabilized, phototherapy can be stopped. In some cases, babies may need to resume phototherapy if bilirubin levels rise again after treatment is stopped.
SEE ALSO: Is Phototherapy Good for Newborns? A Comprehensive Guide
Are There Any Risks or Side Effects of Phototherapy?
Phototherapy is generally considered a safe and effective treatment for jaundice. However, there are some potential risks and side effects that parents should be aware of:
Dehydration:
Phototherapy can increase the baby’s fluid needs, so it’s important to ensure the baby is well-hydrated during treatment. Frequent breastfeeding or bottle-feeding may be necessary to prevent dehydration.
Skin Rash:
Some babies may develop a mild rash during phototherapy, but this usually resolves on its own once treatment is stopped.
Interruption of Bonding:
Phototherapy may require the baby to spend time in the hospital or under lights, which can interrupt the bonding process with the parents. However, efforts are often made to allow for skin-to-skin contact and feeding during breaks in treatment.
When to Seek Medical Attention for Jaundice
While most cases of jaundice are mild and resolve on their own, there are times when medical attention is necessary. Parents should seek medical care if:
The baby’s skin becomes more yellow, especially beyond the face and upper body.
The baby appears lethargic, has difficulty feeding, or shows signs of dehydration.
Jaundice persists for more than two weeks, especially if it started after the first week of life.
The baby develops signs of severe jaundice, such as yellowing of the eyes or very dark urine.
Conclusion
Phototherapy is a widely used and effective treatment for newborn jaundice. It is typically needed when bilirubin levels become high enough to pose a risk of complications, especially in preterm infants or those with underlying risk factors. Early diagnosis, regular monitoring, and timely treatment can help prevent serious complications and ensure a healthy recovery for the baby.
By understanding when phototherapy is needed for jaundice, parents and healthcare providers can work together to manage the condition and promote the best possible outcomes for newborns.
