Newborn jaundice is a common condition that affects many infants during their first days of life. It occurs when there is an elevated level of bilirubin in the baby’s blood, leading to a yellowish tint to the skin and eyes. Although most cases of jaundice are harmless and resolve on their own, some can worsen and require medical intervention. This article aims to guide parents and caregivers on how to identify if a newborn’s jaundice is getting worse and when to seek medical attention.
Understanding Newborn Jaundice
What Is Jaundice?
Jaundice is a medical condition where the skin and whites of the eyes take on a yellow tint. This is due to the buildup of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. In newborns, their immature liver may not be able to efficiently process and excrete bilirubin, leading to its accumulation in the body.
Bilirubin Metabolism in Newborns: Normally, the liver helps to filter out bilirubin from the blood. However, newborns’ livers are often still developing, which can slow down the process. As a result, bilirubin levels can rise during the first few days after birth.
Why It Happens: Most newborns experience some degree of jaundice because their red blood cells break down more rapidly than adults, and their liver enzymes are not yet fully mature.
Types of Jaundice in Newborns
Understanding the types of jaundice can help parents differentiate between normal and concerning symptoms.
Physiological Jaundice: The most common type, physiological jaundice typically occurs between the second and fourth days of life. It is considered a normal part of the newborn adaptation process and usually resolves within two weeks without treatment.
Breastfeeding Jaundice: This can occur when a baby isn’t getting enough breast milk, either due to feeding challenges or a delay in milk supply. It usually develops in the first week of life and improves as breastfeeding is established.
Breast Milk Jaundice: This form develops after the first week and can persist for several weeks. It is thought to be related to substances in the mother’s breast milk that slow down the liver’s ability to process bilirubin. While generally harmless, this type of jaundice should still be monitored to ensure bilirubin levels do not become dangerously high.
Pathological Jaundice: This type is more serious and can develop within the first 24 hours after birth or last longer than two weeks. Pathological jaundice may be caused by conditions such as blood group incompatibility, infections, or genetic disorders. It requires immediate medical attention and intervention.
Recognizing Signs of Worsening Jaundice
Skin and Eye Color Changes
Yellowing of the Skin
A common sign of jaundice is yellowing of the skin, which usually starts on the face and may progress to other parts of the body. This yellow tint is caused by high levels of bilirubin that deposit in the skin tissues.
Progression of Jaundice: As jaundice worsens, the yellowing may spread from the face to the chest, abdomen, and eventually the arms and legs.
Mild Jaundice: In mild cases, the yellow tint may only be noticeable on the face and upper chest.
Moderate to Severe Jaundice: In more severe cases, the yellowing may extend to the baby’s arms and legs. The deeper the yellow, the higher the bilirubin levels are likely to be.
Yellowing of the Eyes
The yellowing of the whites of the eyes (sclera) is another important indicator of jaundice severity.
Mild Jaundice: In the early stages of jaundice, the whites of the baby’s eyes may have a slight yellowish tint.
Moderate Jaundice: As bilirubin levels rise, the yellowing of the eyes becomes more pronounced, signaling that the jaundice is worsening.
Severe Jaundice: In severe cases, the sclera may become intensely yellow, and the baby may need immediate medical assessment to prevent complications.
Changes in Behavior and Feeding
Lethargy or Increased Sleepiness
Newborns with worsening jaundice may become more lethargic and sleep more than usual. While newborns typically sleep a lot, there is a distinction between normal sleep and lethargy caused by jaundice.
Normal Sleep Patterns: Newborns sleep for 16-18 hours a day, waking frequently to feed.
Signs of Lethargy: If a baby is hard to wake up for feeds or seems unresponsive even when awake, this could be a sign that the jaundice is affecting their central nervous system.
Poor Feeding Patterns
Worsening jaundice can interfere with a baby’s ability to feed effectively. This can be due to increased sleepiness or a lack of energy to suck properly.
Normal Feeding Frequency: Healthy newborns typically feed every 2 to 3 hours, whether breastfed or formula-fed.
Poor Feeding as a Red Flag: If the baby is feeding less than usual, not latching properly, or showing signs of dehydration (such as dry lips or reduced wet diapers), this could indicate that the jaundice is becoming more severe.
Changes in Bowel and Urine Color
Stool Color Changes
The color of a newborn’s stool can offer clues about liver function and bilirubin levels.
Normal Stools: In the first few days, a newborn’s stools are dark green or black (meconium). As bilirubin is processed, the stools become yellow or mustard-colored.
Warning Signs: Pale or chalky stools can indicate a serious liver condition, such as biliary atresia, and should prompt immediate medical evaluation. This could signify that bilirubin is not being properly excreted from the body, leading to worsening jaundice.
Urine Color Changes
Urine is another important indicator of how well the newborn is processing bilirubin.
Normal Urine: Healthy infants produce pale yellow urine. In breastfed babies, urine may be more diluted, while formula-fed infants may have slightly darker urine.
Dark Urine: Dark or tea-colored urine in a newborn can be a sign that bilirubin is accumulating in the body rather than being excreted, which is a cause for concern.
Measuring Bilirubin Levels
Understanding Bilirubin Testing
To accurately assess the severity of jaundice, healthcare providers often measure the level of bilirubin in the blood.
Why It’s Important: Bilirubin levels that are too high can lead to a condition known as kernicterus, which can cause permanent brain damage if left untreated.
Who Needs Testing?: All newborns should have their bilirubin levels monitored, especially those at higher risk of jaundice, such as preterm babies or those with blood type incompatibility.
Blood Test for Bilirubin Levels
A blood test is the most accurate way to measure bilirubin levels. This test is typically performed by drawing a small amount of blood from the baby’s heel (heel stick).
Normal Bilirubin Levels: In healthy, full-term newborns, total bilirubin levels are usually less than 12 mg/dL during the first week of life.
Dangerous Levels: If bilirubin levels exceed 15-20 mg/dL, the baby may need treatment to prevent complications. Infants with high bilirubin levels may require phototherapy or, in severe cases, a blood transfusion to quickly lower bilirubin levels.
SEE ALSO: What Levels of Bilirubin Jaundice in Newborns?
Transcutaneous Bilirubin Measurement
For a non-invasive estimate of bilirubin levels, some hospitals use a transcutaneous bilirubinometer, which measures bilirubin through the skin.
How It Works: The device is placed on the baby’s forehead or chest, and it measures the yellow tint of the skin to estimate bilirubin levels.
When to Use It: This test can be used as a quick screening tool, but if bilirubin levels are high, a blood test is typically ordered for more precise measurement.
When to Seek Medical Attention
Signs That Worsening Jaundice Requires Urgent Care
There are several signs that indicate a newborn’s jaundice may be worsening and require medical attention. Parents should be alert to these warning signs and seek care if they notice any of the following:
Rapidly Worsening Skin Color
If the yellowing of the baby’s skin appears to spread quickly or becomes more pronounced within a short period, this could be a sign of rapidly rising bilirubin levels.
What to Do: Contact your healthcare provider immediately if the yellow tint spreads from the face to the lower body within a day or two.
Increased Lethargy or Unresponsiveness
Babies with worsening jaundice may become increasingly difficult to wake or may not respond to stimuli as expected.
What to Do: If the baby is hard to rouse for feeds or seems unusually drowsy or unresponsive, seek medical attention right away, as this can be a sign of bilirubin affecting the brain.
Poor Feeding or Vomiting
Babies with worsening jaundice may stop feeding effectively and may even begin vomiting, which can further complicate their condition by causing dehydration.
What to Do: If your baby refuses to feed, vomits after feeds, or shows other signs of poor feeding, consult your healthcare provider immediately.
Follow-Up Care
Regular Check-Ups
It is important to follow up with your healthcare provider for regular check-ups, especially in the first week of life when jaundice is most likely to peak.
Routine Visits: Most newborns will have a check-up within the first few days of life. During this visit, the healthcare provider will check the baby’s bilirubin levels and overall health.
At-Home Monitoring: Parents should also keep an eye on their baby’s skin color, behavior, and feeding patterns. If any signs of worsening jaundice appear, they should seek immediate care.
Phototherapy Treatment
If bilirubin levels are high, phototherapy may be recommended to help break down the bilirubin in the baby’s skin.
How It Works: Phototherapy involves placing the baby under special lights that help convert bilirubin into a form that can be more easily excreted.
At-Home vs. In-Hospital: In some cases, phototherapy can be administered at home, while in more severe cases, the baby may need to be treated in the hospital under close supervision.
Possible Complications If Untreated
Kernicterus
If severe jaundice is left untreated, the high bilirubin levels can lead to kernicterus, a form of brain damage that can result in long-term neurological problems.
Symptoms of Kernicterus: Early signs include lethargy, poor feeding, high-pitched crying, and a backwards arching of the body. If these symptoms appear, immediate medical attention is critical.
Hearing Loss and Vision Problems
Untreated jaundice can also cause damage to the baby’s hearing and vision.
Monitoring for Issues: Babies with severe jaundice may need follow-up hearing and vision tests as they grow older to ensure that no lasting damage has occurred.
Conclusion
Newborn jaundice is a common condition that can escalate if not monitored properly. By understanding the signs of worsening jaundice and knowing when to seek medical help, parents can ensure the well-being of their infants. Regular monitoring, proper feeding practices, and awareness of behavioral changes are crucial in managing this condition. If there are any concerns about jaundice, parents should always consult with a healthcare professional for guidance and support.
By being proactive and informed, caregivers can help their newborns overcome jaundice and thrive in their early days of life.
You Might Be Interested In
