Neonatal Jaundice – Causes, Symptoms, Tests, Treatment

Neonatal Jaundice – Causes, Symptoms, Tests, Treatment






Bilirubin is a chemical compound (yellow in color) present in the blood that is responsible for breaking down “heme”. In some newborns, there is increased production of bilirubin which gets accumulated causing Neonatal Jaundice. Various factors like health, premature birth, postnatal age and TSB value determines increased secretion of bilirubin in babies. Risk of neonatal jaundice depends on the gestational age and total serum bilirubin levels in the blood. Jaundice causes yellow coloration of the skin and eyes. Treatment for neonatal jaundice includes exchange transfusion of blood and phototherapy depending on the health of the infant.

Level Of Bilirubin :

The symptoms of jaundice become visible with increasing levels of serum bilirubin. If the level of bilirubin is 2-3 mg/dL then discoloration can be seen on the sclera and if he levels ranges from 4-5 mg/dL face of the baby gets yellowish. With more and more volumes of bilirubin level is increased in blood head to foot discoloration can be seen in babies. It can affect the umbilicus if the levels are more than 15 mg/dL and even on the feet if it is more than 20 mg/dL.

Increased level of bilirubin in blood is known as hyperbilirubinemia and it can cause various complications. This condition can become evident in the first week of infants. In severe cases it can lead to kernicterus causing brain damage.

Metabolism :

Hemoglobin present in the blood gets broken down destroying old blood cells and producing new ones. In this process bilirubin is secreted in two forms known as unconjugated bilirubin and conjugated one. Unconjugated form of bilirubin is the compound that binds the albumin for sending it to the liver for absorption. And the conjugated bilirubin is stored in the duodenum and lastly flushed out during excretion process. The unconjugated form of bilirubin is recycled into the blood for further re-absorption.

Neonatal jaundice occurs when there is disruption in the metabolism of bilirubin either due to increased accumulation of conjugated bilirubin or reduction in the liver uptake of unconjugated form.

Neonatal Jaundice Causes :

• Several factors can cause neonatal jaundice. It occurs due to increased production of bilirubin or due to reduction of uptake of bilirubin by the liver or decreased conjugation process. In some cases the stored-up molecules of conjugated bilirubin does not get excreted properly thereby accumulating loads of bilirubin in the body.


• Any problem or dysfunction of liver can lead to cholestasis or neonatal heptatitis.


• Hyperbilirubinemia (increased amounts of bilirubin) can occur in many newborns due to shorter life of freshly produced RBC. Within couple of days, level of bilirubin can increase drastically and often this occurs during the first week of birth. It would resume normal levels after 1-2 weeks.


• Jaundice can occur in breastfed babies during the first week of birth due to increase in enterohepatic circulation. Some infants would consume reduced quantity of milk leading to low calorie intake and Dehydration. This can cause reduction in the volumes of intestinal bacteria resulting in the bilirubin accumulation leading to neonatal jaundice.


• In some infants, intake of breast milk can also cause jaundice. Breast milk contains added quantities of Beta glucuronidase which can trigger deconjugation of bilirubin and this can occur within 2 weeks of birth.


• Neonatal jaundice can develop when the total serum bilirubin levels is more than 5 mg/dL. Babies born with hypoThyroidism or Sepsis can develop jaundice within 1-2 weeks of birth.


• Presence of Sickle Cell Anemia in the newborns or presence of abnormal cell shape can cause neonatal jaundice.


• If there is blood mismatch between the baby and the mother or if there is Rh incompatibility it can cause jaundice.


• Reduction in the level of important proteins or absence of certain enzymes can also cause baby jaundice.


• The risk of neonatal jaundice is high if the mother is taking specific medications during the term of pregnancy.


• Birth infections like Syphilis or Rubella can increase the level of bilirubin causing jaundice.

Symptoms :

Parents should consult their pediatrician if any of the following symptoms are observed in newborns. Poor feeding, vomiting immediately after feeding, sluggishness, mild to moderate fever, repeated crying, and problems in breathing. It is not necessary that the skin color would change to yellow in all the infants that develop jaundice.

Tests :

• The doctor would first complete physical examination of the affected infant paying close attention to skin discoloration. He would check for signs of Hemolytic Anemia. Further he would gather information of maternal Diabetes or history of family jaundice.


• He would check for signs of irritability or lethargy and also identify symptoms of sepsis. The abdomen of the infant is examined for distension or fluid accumulation. Blood culture can be done to check the levels of bilirubin. TSB levels higher than 5 mg/dL/day indicate neonatal jaundice.


• In addition to the above, the doctor may request for CBC, Coombs test and Reticulocyte count test.

Neonatal Jaundice Treatment :

Phototherapy is the standard treatment given for neonatal jaundice. In this therapy, fluorescent light of 425-475 nm wavelengths is directly passed into the baby’s body under controlled settings. Light therapy would effectively isomerize the unconjugated form of bilirubin into water soluble molecule which can be excreted by the kidney. By this method excess of bilirubin can be flushed off the body thus preventing kernicterus. Phototherapy is the best option for neonates born before full gestation period to reduce unconjugated bilirubin from the body.

Exchange transfusion is another method for removing excess of bilirubin for hyperbilirubinemia cases. This method is often preferred for infants with low immunity. Blood sample is taken from the affected infant and is replaced with donor RBC that does not possess the RBC membrane or antigen molecule that is binding the antibodies. If the newborn is sensitive to AB antigens, doctors may use O blood group and Rh negative factor blood can be used in case the new baby is sensitized to Rh antigen. But before proceeding with exchange transfusion, the doctor would check for the levels of unconjugated bilirubin of the baby.

Frequent feeding of the baby is very much essential for affected infants. Similarly frequent bowel movement is to be encouraged for such babies. Phototherapy session for the infant can be easily carried out using a special fiberoptic blanket that is embedded with tiny lights. The baby’s number of feeds, his weight and skin discoloration should be monitored. And the parent should keep watch of the number of bowel movements each day and report it to the doctor.

Prognosis :

Often, the outlook for neonatal jaundice is good. Even without treatment many infants would outgrow the symptoms during the second week. However infants with high levels of bilirubin should be treated quickly to prevent kernicterus.

Tips For Prevention :

• You need to closely observe the baby shortly after the birth and look for signs of skin discoloration and poor feeding.


• Mothers should increase feeding frequently (8-13 times a day) to reduce the risk of jaundice.


• Pregnant women can undergo clinical tests to find out the blood type. And women with Rh negative factor should be monitored for antibodies level of the infant.


• Blood sample of the baby is to be collected and tested for bilirubin level in the first day.

Phototherapy for Jaundice

Phototherapy for Jaundice

Jaundice in infants, characterized by yellowish discoloration of eyes and skin, is a consequence of excess bilirubin in the blood– a break down product of red blood cells. It is a common occurrence in pre-term (babies born before 38 weeks of gestation) and breast-fed babies. While an underlying pathology may be thecause, jaundice in infants is mostly due to an immature liver that is unable to get rid of the excess bilirubin in blood. This article focuses on the treatments used to treat baby born jaundice, like phototherapy.

How Does Phototherapy for Jaundice Work?
The most common treatment option for reducing elevated bilirubin levels in a jaundiced newborn is phototherapy. Phototherapy involves the use of light to bring down the bilirubin levels to normal through a process called photo-oxidation. The process facilitates dissolution of bilirubin in water by adding oxygen to it, which makes it easy for the liver to break it down, remove it out of blood and eventually excrete it in stool and urine. There are two major types of phototherapy:

1. Conventional Phototherapy
In this type of phototherapy, baby is exposed to a specific type of

fluorescent light for several days, which is absorbed into the skin but doesn't damage the skin. It involves:

• Undressing the baby for maximum exposure of skin to light


• Covering baby's eyes to protect the innermost nerve layer (retina)


• Continue breastfeeding in a normal and usual routine


• Regularly assess the bilirubin levels (at least once a day)

While there is no skin damage, there is a potential risk of:

• Skin rash


• Retinal damage due to improper covering of eyes


• Dehydration due to inadequate fluid input or feeding


• Inability to maintain proper body temperature

2. Fiberoptic Phototherapy
Another type of phototherapy for jaundice is fiberoptic therapy which

involves wrapping of a fiberoptic band or blanket around baby's body. Although the therapy offers the convenience of being used at home, it takes longer than the conventional type to bring the bilirubin levels down to normal. Therefore it is an option for babies with mild jaundice who are otherwise healthy.

Understanding the mechanism and equipment is of immense importance here, so that the device works properly in the setting of home. Make sure you're well informed and guided about how to use the device before you start using it. Also, it is recommended to visit the doctor and get the bilirubin levels measured regularly.

Other Treatments for Jaundice In Newborns
Phototherapy for jaundice is undoubtedly a very common treatment option in jaundiced infants. However, in mild or severe cases of jaundice, your healthcare provider may suggest other options and remedies.

1. Change Feeding Patterns
A changed feeding routine or in simple words frequent feeding may help in getting rid of bilirubin faster by causing more bowel movements. In order to take care of mild jaundice, formula fed babies should be given 30-60ml of milk every 2-3 hours, and breastfed babies should have around 8-12 feeds per day for several days.

2. Exchange Transfusion
Besides phototherapy for jaundice and encouraging bowel movements, exchange transfusion is also effective in treating jaundice in babies. This is often advised by doctors for severely jaundiced babies with high levels of bilirubin or if phototherapy has fails to clear that excessive bilirubin.

As the name implies, this procedure first removes small amount of blood from a jaundiced baby via tubes inserted in blood vessels of baby's arms, legs or the umbilical cord; then the removed blood is replaced with blood from a suitable donor. Donor's blood having normal bilirubin replaces baby's high-bilirubin blood allowing the bilirubin levels to drop down to normal.

The transfusion takes several hours and the baby is constantly monitored throughout the procedure. Potential risk is bleeding and this can be treated. Within 2 hours of transfusion, bilirubin levels in baby's blood are measured and the procedure is repeated if the levels are still elevated.

3. Intravenous Immunoglobulin
The last alternative for phototherapy for jaundice is intravenous immunoglobulin. For an infant with jaundice due to other underlying pathology, treating the illness or pathology is of immense importance to treat the jaundice itself. In case of jaundice due to rhesus disease, where the baby has rhesus positive blood and the mother has rhesus negative blood, intravenous immunoglobulin (IVIG) is administered. IVIG is often administered when the bilirubin levels are continuously rising and the phototherapy has failed to bring them down to normal.

This type of jaundice is actually a consequence of difference in blood types between the mother and baby. It occurs when the antibodies from mother that are being carried by the baby cause the breakdown of cells in the baby. This intravenous transfusion of immunoglobulin reduces the antibody level, the intensity of jaundice and eventually the need of an exchange transfusion.

Jaundice in Babies

Jaundice in Babies

Jaundice is a condition that can occur in adults or in babies when the bilirubin levels in the blood increase above a certain level. This condition is caused when the red blood cells break down faster than the liver can excrete the bilirubin. The yellow skin, or jaundice, that results from the bilirubin may be a normal condition in a baby, but it is a condition that your baby’s pediatrician will want to follow. Once the condition occurs, there are many remedies and treatments that you can use. Causes of Jaundice in Babies
It is important to know the possible causes and risk factors for jaundice in your baby. There are many possible causes of jaundice in babies: Too Much Bilirubin (Hyperbilirubinemia)
The primary cause of jaundice in babies is an excess of bilirubin in the blood stream. This condition is referred to as hyperbilirubinemia. As red blood cells age, there is a normal break down releasing bilirubin into the blood. Since the baby’s liver is immature, it is not able to remove the bilirubin. Hence, most newborns will develop physiologic jaundice that usually appears two or three days after birth. Other Causes
Other causes of jaundice in a baby may include: liver disease, abnormal red blood cells, bleeding internally, bacterial or viral infections, blood incompatibility between the mother and infant, or lack of certain enzymes. Risk Factors of Jaundice in Babies
1. Bruising During Birth
If the baby has bruising from the birth process, red blood cells will be broken and more bilirubin will be released. 2. Premature Birth
Prematurity is one of the most common causes of jaundice because the liver will also be less well developed in a premature birth. A premature baby will also have fewer bowel movements which is the primary way bilirubin is excreted. 3. Being Poorly Breastfed
Finally, if your baby is not breastfeeding well, Dehydration may cause an increased risk of jaundice. It is thus important to ensure that you baby is breastfed well and get the calories and nutritions needed. 4. Blood Type Different from the Mother’s
Occasionally, jaundice will develop if the baby’s blood type and mother’s blood type are different. This condition may cause red cells to break down more quickly releasing bilirubin more quickly. Symptoms of Jaundice in Babies
It is important to understand the symptoms of jaundice and to know when you should take your baby in to see your healthcare provider. Symptoms

• The first thing you will notice in jaundice is that your baby’s facial skin will have a yellow tinge. Check for this by gently pressing on the baby’s forehead in natural sunlight; if the skin is yellow where you pressed, your baby probably has jaundice.


• As the jaundice progresses, you will notice the white part of the eye will become yellow.


• If the jaundice gets bad enough, you may begin to see yellowing of the skin of the arms, legs, and torso.

When to See a Doctor
Most cases of physiologic jaundice in a newborn are at their highest two to seven days after birth. Since many mothers and infants are discharged before that time, you should know the following symptoms to watch for:

• The jaundice gets worse or does not go away within three weeks;


• The whites of the baby’s eyes become yellow;


• The skin on arms, legs or abdomen becomes yellow;


• Jaundice lasting for more than 3 weeks;


• Your baby is not eating well and is not gaining weight;


• Your baby seems sick, is hard to wake up, or has high-pitched crying.

Home Remedies for Jaundice in Babies
Enough Natural Sunlight
It is likely that your baby will be discharged from the hospital with jaundice and that your healthcare provider will instruct you in a couple of home remedies for physiologic jaundice. First, many practitioners will recommend that your newborn gets plenty of natural light each day; do not expose the baby to direct sunlight, but be sure to open the shades in his room and let the natural light in. Frequent Feeding—Breastfeeding & Supplemental Feeding
Feed frequently to be sure your baby has sufficient bowel movements to rid his body of bilirubin. If your baby is not breastfeeding well, be sure to keep him hydrated by offering additional bottle feedings. Offer your breast or a bottle every two hours. Remember that your newborn will need as many as 12 feedings of one to two ounces each day during the first week of his life. Treatments of Jaundice in Babies
If your baby has mild jaundice, you can usually expect that it will not need treatment and will disappear within three weeks. If the jaundice is more severe, your healthcare provider may prescribe certain treatments: 1. Phototherapy (Light Therapy)
In the hospital, your baby may be placed under special lights that change the bilirubin molecules so the baby can excrete them more easily. Some hospitals may also have light-emitting pads that will do the same thing. Since these light rays can harm your baby’s eyes, the nurses will cover his eyes with a shield during the treatment. 2. IVIg (Intravenous Immunoglobulin)
If the jaundice is caused by incompatible blood types between the baby and mother, the baby might be give immunoglobulin through the vein that will combat the antibodies in the baby’s body. These antibodies can cause increased breakdown in red blood cells, so if the antibodies can be neutralized, the breakdown will be decreased. 3. Exchange Transfusion of Blood
If the baby’s jaundice is very severe and is not improved by the other treatments, your doctor may prescribe exchange blood transfusions. This is NOT a common procedure, but if the baby’s jaundice does not resolve, this may be done. In this procedure, small amounts of blood are taken from the baby, diluted, and then transfused back into the baby. Again, typically jaundice will respond to the other treatments and exchange transfusions will not be needed.

Jaundice

Jaundice






Jaundice is a condition that causes yellowish color of the skin and the eyes due to increased levels of bilirubin in blood. This is known as hyper-bilirubinemia. As such jaundice is not a disease but it indicates the underlying medical condition. It can develop due to several medical issues and sometimes it can be life threatening causing death. Exact cause of jaundice is to be determined to start suitable treatment.

In healthy condition, the level of bilirubin in blood would be 3-20 per liter but when jaundice develops the level would go beyond 35 -40 mo/L. Jaundice is caused by pre-hepatic, hepatitis and post hepatic conditions. Jaundice needs to be treated after knowing the underlying medical causes. Neonatal jaundice is common in newborns but it is harmless and does not cause serious effects.

Causes :

Whenever the metabolism of bilirubin in the blood is disturbed it can cause jaundice. Bilirubin is a component produced during the breaking up of red blood cells and they release hemoglobin in this process. It is the heme that gets metabolized into bilirubin which is then released into the blood. When they reach liver, the bilirubin is further broken down and sent into the intestines. A portion of birlirubin is expelled in the form of feces and other part is further metabolized to get expelled through urine.

If there is any dysfunction in the above metabolism it can cause accumulation of bilirubin leading to jaundice. Basically problem can occur in 3 different stages namely

• Metabolism of bilirubin can get disturbed before they are sent to the liver (pre hepatic)


• Metabolism can get dysfunctional in the liver (hepatic)


• Metabolism of bilirubin can get affected after it is sent from the liver (post hepatic)

Pre Hepatic :

Various medical conditions can cause hemolysis (loss of red blood cells) which can lead to increase in the level of bilirubin. The liver would become incapable to metabolize such extreme high levels of bilirubin causing jaundice. Malaria, Thalassemia, sickle cell disease, exposure to toxins and G6PD deficiency and certain other autoimmune disorders can affect the normal level of bilirubin in the blood.

Hepatic :

Jaundice can develop due to increase in the conjugated or un-conjugated levels of bilirubin. Hepatitis infection caused by virus, liver cirrhosis (due to over consumption of alcohol), Crigler Najjar syndrome, certain drugs and Liver Cancer can cause abnormality in the functions of liver leading to jaundice.

Post Hepatic Factors :

If there is disruption of normal functions of excretion of bilirubin (which is now changed into bile) from the liver, it can cause jaundice. Any medical conditions that affect the functions of bile ducts or Pancreas like gallstone formation, Pancreatitis, bile duct cancer, cholangitis and parasitic infection of pancreas can lead to jaundice.

Symptoms :

The major symptom of jaundice is the yellowish coloration of the skin. It can be mild to moderate and severe based on the medical issues inside. The mucus membranes turn yellow in color and for many people the white portion of the eyes will turn yellow. The symptoms are not the same for all people it varies with individual’s health condition and intensity of the problem.

Some other common signs of jaundice are Diarrhea, nausea, vomiting, itching or skin, change in normal color of the skin (dark), bleeding of rectum, fever, chills, loss of weight, loss of appetite, mild confusion of thoughts, swelling of abdomen and legs.

Who are at risk?

A person with hereditary disorder like thalassemia is more prone to get jaundice than others. Hereditary spherocytosis can also cause jaundice. A person who drinks alcohol heavily is at high risk of developing jaundice and cirrhosis. People who get infected with virus hepatitis of A, B, or C is prone to develop liver problems and jaundice.

Diagnosis :

It is difficult to determine the underlying medical condition that causes jaundice. Your doctor will complete the physical exam and order for series of tests like blood count, urine analysis, and liver function test and electrolytes level. In addition he may request for more tests like ultrasound scanning of the liver, pancreas and gallbladder to rule out any abnormalities. Further you may be asked to undergo CT or MRI scan based on the results. If required, he may do a liver biopsy by collecting a small tissue sample from your liver.

Treatment :

Treatment options may vary with individual and based on the underlying medical issues. Your doctor is the right person to devise suitable plan for treating jaundice. Some people are hospitalized if they have severe symptoms and most of them can be treated as outpatients. Antiviral medications are given if jaundice has developed due to hepatitis infection. The person will be asked to repeat certain tests mentioned above and the results are compared and monitored closely.

If the underlying cause is alcohol consumption, you will have to quit drinking with the help of your doctor. Alcoholic hepatitis and pancreatitis can develop due to alcohol abuse. Overdose of certain medications and toxins can cause jaundice. In such cases proper antidote is given. Corticosteroids are often prescribed for treating jaundice developed from autoimmune disorders. For patients with severe anemia, blood transfusion is to be done based on their symptoms and test results. If liver cancer or pancreatic cancer has caused jaundice, your doctor will initiate suitable treatment like surgery or chemotherapy. In serious cases, gallstone surgery and liver transplantation is done for saving the life of the patient.

Complications :

For many people, jaundice can be mild to moderate and for some it can cause potential life threatening complications like severe anemia, Sepsis, internal bleeding, and abnormal levels of electrolytes, chronic hepatitis, liver/Kidney Failure and even death.

Prevention :

You cannot totally prevent development of jaundice but you can always reduce the risk factors. Do not take overdose of medications and consult your pharmacist or GP in case of doubt. People with G6PD problem should be very careful in using certain medications. Avoid having unprotected sex with strangers and do not share needles since you are at risk of developing autoimmune disorders.

Vaccination is available for hepatitis and you can prevent developing it. Practice good hygiene while using public toilets and eating food/water. Avoid traveling to areas prone to malarial epidemic. If you are habitual drinker, reduce the intake of alcohol immediately with the help of your doctor/counselor. Quit smoking and drinking since both can harm your lungs and liver.

Prognosis :

Jaundice can become fatal if there is delay in treatment and if the diagnosis is not made correctly. Prognosis of jaundice varies squarely with the individual’s case history. There are many patients who have recovered fully from jaundice but there are some serious cases that are fatal.