Neonatal Jaundice

Neonatal jaundice is a common condition in newborns characterized by yellowing of the skin and the whites of the eyes. This discoloration is caused by an excess of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. In newborns, the liver is often not mature enough to process bilirubin effectively, leading to its accumulation. While mild jaundice is typically harmless and resolves on its own, severe cases require medical intervention to prevent complications such as brain damage.

Types of Neonatal Jaundice

Physiological Jaundice

Physiological jaundice is the most common type and appears within the first few days of life. It occurs because a newborn’s liver is still developing and may not be efficient at processing bilirubin. This type usually resolves without treatment within two weeks.

Breastfeeding Jaundice

Breastfeeding jaundice can occur in breastfed babies due to insufficient breast milk intake, leading to dehydration and less frequent bowel movements. This results in reduced bilirubin excretion. Ensuring the baby feeds frequently can help manage this type.

Breast Milk Jaundice

Breast milk jaundice develops after the first week of life and can persist for several weeks. It is thought to be caused by substances in breast milk that inhibit the liver’s ability to process bilirubin. Despite the prolonged jaundice, it is usually not harmful.

Hemolytic Jaundice

Hemolytic jaundice is caused by an underlying condition such as blood group incompatibility between the mother and baby (e.g., Rh or ABO incompatibility). This leads to increased red blood cell breakdown, resulting in higher bilirubin levels. It requires prompt medical treatment.

Pathologic Jaundice

Pathologic jaundice appears within the first 24 hours of life and is often due to more serious conditions like liver disorders, infections, or genetic enzyme deficiencies. It requires immediate medical evaluation and intervention.

Cause of Neonatal Jaundice

Neonatal jaundice is primarily caused by the immaturity of the liver in newborns, which is unable to process bilirubin efficiently. Other causes include blood type incompatibility, infections, enzyme deficiencies, and certain genetic disorders. Factors such as premature birth, bruising during delivery, and poor feeding practices can also contribute to the condition. In some cases, specific substances in breast milk can prolong jaundice.

Symptoms of Neonatal Jaundice

The most noticeable symptom of neonatal jaundice is the yellowing of the skin and the whites of the eyes. This typically starts on the face and spreads down the body. Other symptoms may include poor feeding, lethargy, dark urine, and pale stools. In severe cases, high levels of bilirubin can lead to complications such as kernicterus, a type of brain damage indicated by symptoms like high-pitched crying, fever, and arching of the back.

Diagnosis of Neonatal Jaundice

Clinical Examination

A healthcare provider will first perform a physical examination, looking for signs of jaundice by examining the skin and eyes. 

Transcutaneous Bilirubinometer

A non-invasive device called a transcutaneous bilirubinometer can measure bilirubin levels through the skin. It provides a quick and painless estimate of bilirubin concentration.

Serum Bilirubin Test

If jaundice is suspected, a blood test measuring the total serum bilirubin (TSB) levels is often performed. This test determines the exact amount of bilirubin in the baby’s blood and helps assess the severity of jaundice.

Coombs Test

For cases suspected to be caused by blood type incompatibility, the Coombs test can detect antibodies that may be attacking the baby’s red blood cells. 

Complete Blood Count (CBC)

A CBC can provide information about the overall health of the baby’s blood cells, helping to identify hemolytic jaundice or other underlying conditions.

Treatments of Neonatal Jaundice

Phototherapy

Phototherapy is the most common treatment for neonatal jaundice. The baby is placed under special blue lights that help break down bilirubin in the skin, allowing it to be excreted more easily. This treatment is usually effective and safe.

Exchange Transfusion

In severe cases where bilirubin levels are dangerously high, an exchange transfusion may be necessary. This procedure involves replacing the baby’s blood with donor blood to quickly reduce bilirubin levels.

Intravenous Immunoglobulin (IVIg)

For jaundice caused by blood type incompatibility, IVIg can reduce the need for an exchange transfusion. It works by blocking antibodies that attack the baby’s red blood cells.

Enhanced Feeding

Increasing the frequency and amount of feedings can help reduce bilirubin levels by promoting bowel movements and excretion of bilirubin. In cases of breastfeeding jaundice, ensuring adequate milk intake is crucial.

Treating Underlying Conditions

If jaundice is caused by an underlying condition such as an infection or liver disease, treating the primary condition is essential. This may involve antibiotics for infections or specific treatments for metabolic or genetic disorders.

Probiotic Supplements

Recent studies suggest that probiotic supplements might help reduce bilirubin levels in newborns by promoting gut health and aiding in bilirubin excretion. However, this treatment is still under investigation and not widely adopted.

Fiber Optic Blanket

A fiber optic blanket is a newer method that uses light therapy in a portable form. The baby lies on the blanket, which emits light and helps break down bilirubin. It can be used in conjunction with conventional phototherapy or as an alternative.

Neonatal jaundice is a common and typically manageable condition in newborns. Early detection and treatment are crucial to prevent complications. While most cases resolve with minimal intervention, severe jaundice requires prompt medical attention. Understanding the types, causes, symptoms, and treatments of neonatal jaundice is essential for parents and caregivers to ensure the health and well-being of their newborns. If you have concerns about your baby’s jaundice, consult your healthcare provider for appropriate guidance and care.