Understanding this condition can help you decide when to seek medical guidance.
What is Newborn Jaundice?
Jaundice in newborns occurs when there’s too much bilirubin in the baby’s blood. Bilirubin is a yellow pigmented substance produced when red blood cells break down. While a baby is in the womb, the mother’s liver clears bilirubin for them. After birth, the baby’s liver takes over. But it’s often not fully developed, which can lead to a buildup of bilirubin and cause the skin and eyes to look yellow. This condition is very common, affecting up to 85 per cent of all live births. Most cases are mild and resolve on their own within days. But in rare cases, high bilirubin levels can lead to serious complications if not treated.Causes of Newborn Jaundice
Several factors can cause jaundice in newborns. These are the main types:- Physiological jaundice: This is the most common type, appearing on the second or third day of life. It happens because a newborn’s liver isn’t yet efficient at removing bilirubin, leading to a temporary buildup. It’s usually harmless and clears up within two weeks.
- Breastfeeding jaundice: Occurs in the first week if a baby isn’t feeding well or if the mother’s milk is slow to come in. This leads to dehydration and less frequent bowel movements, which slows bilirubin removal.
- Breast milk jaundice: Different from breastfeeding jaundice, this type starts after the first week and can last 2 to 3 weeks or more. Substances in breast milk may interfere with the liver’s ability to process bilirubin.
Pathological Jaundice
Jaundice can also be caused by an underlying medical condition. This type is known as pathological jaundice and may include:- Blood type incompatibility (rhesus or ABO incompatibility), where the mother’s antibodies attack the baby’s red blood cells.
- Abnormal red blood cell shapes, such as in sickle cell anaemia.
- Infections like sepsis, rubella, or syphilis.
- Internal bleeding, such as cephalohematoma from a difficult delivery. This happens when blood accumulates under the baby’s scalp.
- Higher red blood cell counts, often seen in twins or small-for-gestational age babies.
- Liver or bile duct issues, like hepatitis or biliary atresia.
- Enzyme deficiencies or genetic disorders.
- Low oxygen levels (hypoxia) or hypothyroidism.
Symptoms of Newborn Jaundice
Noticing the symptoms of this condition early is important to act fast if treatment is needed. Some of the common ones are:- Yellow skin or eyes, best seen in natural daylight.
- Yellow tint under the tongue.
- Drowsiness or being very sleepy.
- Pale greenish-yellow stools in breastfed babies or greenish-mustard stools in bottle-fed babies.
- Dark urine (a healthy newborn’s urine is usually clear or light yellow).
- Bright yellow or orange skin, especially on the abdomen, arms, or legs.
- Unusual eye movements.
Risk Factors for Newborn Jaundice
Certain risk factors increase the chances of a baby developing jaundice or experiencing more severe cases. These may include:- Premature birth: Babies born before 38 weeks have less developed livers, making it harder to process bilirubin.
- Bruising during delivery: Bruises from birth can lead to more red blood cell breakdown and increased bilirubin levels.
- Blood type differences: If your blood type is different from your baby’s (Rh-negative mother with an Rh-positive baby), antibodies from you may break down your baby’s red blood cells faster.
- Breastfeeding challenges: Babies who don’t get enough breast milk due to nursing difficulties or delayed milk production are at higher risk.
Complications of Untreated Jaundice
Most cases of jaundice are harmless, but high bilirubin levels may lead to serious complications.Acute Bilirubin Encephalopathy (ABE)
This happens when bilirubin, which is toxic to brain cells, crosses into the brain. It can build up in the brain and damage it. This condition is rare but dangerous, and its signs include:- Difficulty waking your baby or listlessness.
- Poor feeding or trouble nursing/sucking from a bottle.
- High-pitched crying or irritability.’
- Fever.
- Arching of the neck or body.
Kernicterus
Kernicterus is the long-term result of untreated acute bilirubin encephalopathy. It can lead to serious problems like:- Involuntary movements (athetoid cerebral palsy).
- Permanent upward gaze.
- Hearing loss.
- Poor development of tooth enamel.
Diagnosing Newborn Jaundice
Doctors usually check for jaundice before you leave the hospital after delivery and during follow-up visits in the first week.Bilirubin Level Tests
- A transcutaneous bilirubinometer is a non-invasive device that checks serum bilirubin levels by shining light through the skin, usually on the forehead of the baby.
- A blood test (total serum bilirubin, or TSB) confirms bilirubin levels by taking a small sample.
- Complete blood count to check red blood cell levels.
- Reticulocyte count to assess new red blood cell production.
- Blood type test to check for incompatibility.
- Coombs test to detect immune-related red blood cell destruction.
- Urine sample to rule out infections.
- Liver function tests are used to check for liver issues.
Treatment Options for Newborn Jaundice
Treatment may be needed if bilirubin levels are high or rising quickly. Doctors might recommend the following treatment options:- Frequent feeding: Feeding your baby 8 to 12 times a day, every 2 to 3 hours, encourages frequent bowel movements and helps remove bilirubin. This is often enough for mild cases.
- Phototherapy: Your baby is placed under special blue lights wearing only a diaper and protective eye patches or goggles to prevent retinal damage from the light. The light changes bilirubin into a form that’s easier to excrete. This usually takes 1 to 2 days, but may continue longer for severe cases until bilirubin levels drop to a safe range. It can sometimes be done at home with a fibre-optic blanket or a light-emitting bed.
- Exchange transfusion: In rare cases where phototherapy doesn’t work, your baby’s blood is replaced with donor blood in a neonatal ICU to lower bilirubin levels quickly.
- Intravenous immunoglobulin (IVIg): If jaundice is due to blood type incompatibility, IVIg can reduce the mother’s antibodies attacking the baby’s red blood cells.
Preventing Newborn Jaundice
Jaundice can’t always be prevented, but you can reduce the risk of severe cases by taking these steps:- Feed your baby frequently.
- Check your baby’s skin and eyes for yellowing, especially in the first 5 days, when bilirubin levels peak.
- Schedule a doctor’s visit within 2 to 5 days after hospital discharge.
- If you’re pregnant, get your blood type tested to check for any incompatibilities. After birth, your baby’s blood type may be tested via the umbilical cord if you’re Rh-negative.
When to Seek Medical Help
It’s crucial to act quickly if you notice signs of jaundice or if it worsens. Contact your doctor if:- Your baby’s skin becomes brighter yellow or orange.
- Your baby is very sleepy, hard to wake, or fussy.
- Your baby isn’t feeding well.
- Jaundice lasts longer than 2 weeks.
- If your baby has a fever.
- If your baby has a stiff, limp, or floppy body.
FAQs on Newborn Jaundice: Causes, Symptoms, and Treatment
- Is newborn jaundice dangerous?
Most cases are mild and harmless, but severe jaundice can cause serious brain damage if left untreated. - What treatments are available for newborn jaundice?
Treatment may include frequent feeding, phototherapy with special lights, or in severe cases, blood transfusion.
