NEONATAL JAUNDICE
Jaundice
Jaundice is a medical condition of the liver which is associated with the yellowing of the skin, the eye, and even of the mucous membrane. Jaundice can happen with various health conditions but often signify an issue with the liver or the bile duct. When the liver does not function the way it ought to function, it can cause the build-up of a substance known as bilirubin in the blood.
This medical condition can develop in people of all ages, however, newborns and even older adults are at major risk of developing this medical condition.
Neonatal Jaundice
Neonatal jaundice occurs after birth and is often referred to as newborn jaundice. Neonatal jaundice is when a baby’s skin and eyes turn yellow from too much bilirubin. In the case of neonatal jaundice, it is most times caused by the weakness of the liver and most often resolves on its own as the newborn’s liver matures. Normally, the liver is saddled with the responsibility of breaking down bile into bilirubin and its excretion from the body. However, in newborns, the liver may not be mature enough to carry out this responsibility, hence, the accumulation of bilirubin in the blood gives rise to this medical condition known as jaundice whose major symptoms include the yellowing of the eyes and skin of the newborn.
In summary, neonatal jaundice occurs because the baby’s blood contains an excess of bilirubin, a yellow pigment of red blood cells, and most especially because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. Infant jaundice is a common condition, particularly in babies born before 38 weeks gestation (preterm babies) and some breastfed babies. In some babies, an underlying disease may cause infant jaundice.
Categories of Neonatal Jaundice
There are two categories of neonatal jaundice;
- Physiological Jaundice: This is the most common type of jaundice. This means the baby’s metabolism cannot clear out bilirubin as quickly as it is produced. This type typically develops in a few days and clears up on its own in a few weeks when the breakdown of red blood cells slows and liver function improves.
2. Pathological Jaundice: Pathological jaundice on the other hand means that other underlying issues are preventing the excretion of bilirubin from the bloodstream of the newborn. This particular type of jaundice may show up between the first 24hrs of birth and some of the possible causes of this condition may include;
- blood type incompatibilities between mother and newborn such as rhesus factor (Rh) or ABO
- breakdown of red blood cells (hemolysis)
- conditions that affect how the body processes bilirubin like Gilbert’s syndrome and Crigler-Najjar syndrome
- diabetes in the birthing parent
- Intestinal obstruction
- Breastmilk jaundice, a reaction to substances in the milk
- breastfeeding jaundice, which can happen if the baby isn’t feeding well
- Internal Bleeding (hemorrhage)
- An enzyme deficiency
Pathological jaundice can also be caused by certain medications, such as certain antibiotics.
Symptoms of Neonatal Jaundice
The first sign of jaundice is the yellowing of a baby’s skin and eyes. This symptom may start in the face and then spread across the body. With physiological jaundice, the yellowing may begin and peak within 2 to 5 days after birth. However, with other pathological causes, jaundice may begin closer to birth. It is important to take note that the yellowing can be harder to see in darker skin tones. Howbeit, another way to tell is by pressing your finger lightly on the baby’s skin. The spot should briefly appear paler. If it looks more yellow, it’s likely a sign of jaundice.
If you have concerns or are unsure about the observed symptoms, contact your baby’s doctor, particularly if the whites of their eyes look yellow. This is because if untreated, severe newborn jaundice can lead to acute bilirubin encephalopathy, which is caused by the toxic levels of bilirubin in the brain. A baby may get a fever, act restless, have a shrill cry, refuse to feed, and curve their neck and body backward. This can, in turn, progress to kernicterus, which is permanent brain damage.
Risk Factors of Neonatal Jaundice
Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:
- Premature birth. A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.
- Significant bruising during birth. Newborns who become bruised during delivery and get bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.
- Blood type. If the mother’s blood type is different from her baby’s, the baby may have received antibodies through the placenta that cause an abnormally rapid breakdown of red blood cells.
- Breast-feeding. Breastfed babies, particularly those who have difficulty nursing or getting enough nutrition from breastfeeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breastfeeding, experts still recommend it. It’s important to make sure your baby gets enough to eat and is adequately hydrated.
Diagnosis
Though distinct yellow coloration on the skin and the eyes of the newborn confirms that a baby has jaundice, however, additional tests may be needed to determine the severity. Babies who develop jaundice will get a bilirubin blood test to determine the levels of bilirubin in their blood. Additional tests may be needed to see if a baby’s jaundice is due to an underlying condition. This may include testing your baby for their complete blood count, blood type, and Rh incompatibility. Additionally, a Coombs test may be done to check for antibodies that show an elevated risk of increased red cell breakdown (hemolysis).
Prevention
The best preventive measure for neonatal jaundice is adequate feeding. Breastfed infants should have eight to 12 feedings a day for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week. If you or your doctor thinks there is a likely underlying issue that could cause jaundice in your newborn, there are tests that can verify this so that you or the baby can get preventive treatment if appropriate. For example, during pregnancy, you can have your blood type tested to rule out the possibility of Rh incompatibility. If you’re Rh-negative, you can get intravenous immunoglobulin during pregnancy.
Treatment
- Mild jaundice will usually resolve on its own as a baby’s liver matures. Frequent feedings (at least 8 times a day) will help babies pass bilirubin through their bodies.
- More severe jaundice may require other treatments. Phototherapy (light therapy) is a common and highly effective method of treatment that uses light to break down bilirubin in your baby’s body. In phototherapy, your baby will be placed on a special bed under a blue spectrum light while wearing only a diaper and special protective goggles. A fiber-optic blanket may also be placed underneath your baby.
- In very severe cases, an exchange transfusion may be necessary. In this procedure, a baby receives small amounts of blood from a donor or a blood bank. This replaces the baby’s damaged blood with healthy red blood cells. This also increases the baby’s red blood cell count and reduces bilirubin levels.
In addition, if there’s an underlying cause, the baby will need to be treated for the condition to resolve symptoms.
REFERENCES
https://www.healthline.com/health/newborn-jaundice#Treatment
https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865