Definition

Neonatal jaundice refers to a yellowish discoloration of the skin and eyes of newborns. This condition commonly occurs and it is generally not dangerous, although there are other causes of jaundice that can be more serious.

Causes

Jaundice, also known as icterus, occurs due to the accumulation of bilirubin in the blood. Bilirubin is a yellowish substance produced when red blood cells, which carry oxygen throughout the body, are broken down. Jaundice is common in newborns because they have a higher number of red blood cells, leading to increased breakdown. Additionally, the newborn liver may not fully develop, making it less effective at removing bilirubin from the blood.

Typically, jaundice resolves on its own by around 2 weeks of age as the liver becomes more efficient at processing bilirubin. However, if jaundice appears shortly after birth (within the first 24 hours) or persists beyond 2 weeks, it may indicate underlying health conditions. Some causes of abnormal jaundice include:

• Hypothyroidism is when the thyroid gland doesn't produce enough thyroid hormone.
• Blood type incompatibility between the mother and baby leads to an immune reaction and red blood cell breakdown.
• Rhesus disease occurring when the mother has rhesus-negative blood and the baby has rhesus-positive blood.
• Urinary tract infections.
• Crigler-Najjar syndrome, a congenital disorder affecting the enzyme responsible for metabolizing bilirubin.
• Blockage or disorders of the bile ducts and gallbladder, hindering bilirubin excretion.
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetic enzyme disorder that can cause severe jaundice.

Risk factor

Jaundice is a common condition in newborns, with approximately 6 out of 10 babies experiencing it. Premature babies born before 37 weeks of gestation are even more likely to develop jaundice, with about 8 out of 10 affected. However, only around 1 out of 20 babies have bilirubin levels high enough to require treatment.

Although the exact reasons are not yet fully understood, breastfeeding-related issues can increase a baby's risk of developing jaundice, which may persist for a month or more. These issues can arise from the enzyme content in breast milk or inadequate breastfeeding practices.

Symptoms

If a baby has jaundice, their skin may appear slightly yellowish, though this change can be more challenging to detect on darker-skinned babies. However, the following body parts may show more noticeable color changes:

• The white part of the eyes
• Inside the mouth
• The soles of the feet
• The palms of the hands

Other symptoms of neonatal jaundice may include:

• Dark yellow urine (a newborn's urine should not be colored)
• Pale stools (normal stool color for a newborn is yellow or orange)
• Excessive sleepiness or constant lethargy
• Refusal or decreased interest in breastfeeding

Symptoms of neonatal jaundice typically manifest around 2 days after birth and often improve without treatment by the time the baby is around 2 weeks old. In premature babies, who are more prone to jaundice, symptoms may appear 5-7 days after birth and usually resolve within 3 weeks.

Diagnosis

Your baby will undergo examinations, including a search for the cause of jaundice, within 72 hours after birth as part of the newborn physical examination. These examinations are essential for determining whether therapy is necessary.

Visual examination: Your baby will undergo a visual examination to assess for signs of jaundice. During this examination, your baby's clothing will be removed to allow for inspection of the skin under good, natural light. The following areas may be examined:

• The whites of the baby's eyes
• The baby's gums
• The color of the baby's urine or stools

Bilirubin examination: If jaundice is suspected, your baby's blood bilirubin levels must be checked. This can be done using:

• A bilirubinometer: This small device emits light onto the baby's skin and measures bilirubin levels by analyzing the skin's reflection or absorption of light. It is the primary method used to detect jaundice in babies.
• Blood tests: In some cases, blood tests from a blood sample may be necessary to measure bilirubin levels in the blood serum. These tests are typically performed if your baby develops jaundice within 24 hours after birth or if previous bilirubin test results are elevated.

The detected bilirubin levels in your baby's blood are crucial in determining whether therapy is required. Further blood tests may be necessary if jaundice persists for more than 2 weeks or if therapy is deemed necessary.

These blood tests will analyze:

• The baby's blood type, which is compared to the mother's blood type to assess compatibility.
• The presence of antibodies bound to the baby's red blood cells, which can indicate immune system reactions.
• The red blood cell count in the baby.
• The presence of specific infections.
• The presence of certain enzyme deficiencies.

These tests help identify any underlying causes for the elevated bilirubin levels and guide appropriate treatment decisions.

Management

Management for neonatal jaundice is typically unnecessary because symptoms usually resolve within 10 to 14 days, although in some cases, it may last longer. Therapy is usually only recommended if test results indicate very high bilirubin levels in the baby's blood due to the risk of bilirubin entering the brain and causing brain damage.

There are two main therapies available in the hospital to decrease your baby's bilirubin levels rapidly:

• Phototherapy: This involves exposing the baby's skin to a specific type of light, which converts bilirubin into a form easier for the liver to break down.
• Exchange transfusion: In this procedure, the baby's blood is removed through a thin tube (catheter) inserted into the blood vessels and replaced with blood from a matching donor.

Complications

If a baby with high levels of bilirubin is not treated, there is a risk of permanent brain damage. This condition is called kernicterus, and it can lead to symptoms such as decreased consciousness, reluctance to breastfeed, breathing difficulties, and reduced reflexes.

Prevention

Jaundice in newborns is a normal occurrence and often cannot be prevented. However, you can reduce your baby's risk of jaundice by breastfeeding more frequently. Frequent feeding stimulates bowel contractions, aiding in the excretion of bilirubin.

• For breastfed babies, aim to breastfeed your baby 8 to 12 times a day during the first few weeks of life.
• For formula-fed babies, offer your baby 30-60 ml of formula milk every 2 to 3 hours during the first few weeks of life. Ensure a minimum of 8 feedings in a 24-hour period.

When to see a doctor?

As part of the newborn assessment, your baby will undergo a jaundice examination within 72 hours after birth. If signs of jaundice appear after this period, contacting a doctor promptly is crucial. While jaundice is often harmless, it's essential to determine whether your baby requires treatment.

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