What Is Neonatal Jaundice?

Jaundice is caused by the buildup of chemicals in the body's tissues, particularly bilirubin, found in red blood cells. It can occur at any stage of life due to various reasons. Neonatal jaundice is expected in the first two weeks of a baby's life and is usually harmless, but it should be investigated if it appears within the first 24 hours or persists beyond two weeks. It is characterized by the yellowing of the skin and the whites of the eyes due to increased bilirubin levels.

Complications of Neonatal jaundice in babies

As mentioned, the above-increased level of bilirubin in the tissues is the cause of jaundice.

Red blood cells are more present in newborn babies than in adults, and they break down, which leads to the build-up of bilirubin. As the bilirubin is made too quickly, the liver will break it all down, increasing the level of bilirubin.

Types of Jaundice

Jaundice typically disappears in two weeks as red blood cell breakdown decreases and the liver processes bilirubin.

• Physiological jaundice:
  • Common cause
  • Appears between days 2-4
  • Peaks by day 7
  • Disappears by day 14
• Severe jaundice indicators:
  • Appears on the first day
  • High bilirubin levels
  • Baby is irritable or not feeding well
  • Persists after two weeks
• Serious signs:
  • Liver problems
  • Pale stools
  • Dark urine stains in the nappy

Signs or Symptoms of Neonatal jaundice

Neonatal jaundice is characterized by:

• Yellowing of the Skin: Noticeable yellowing, especially in the face and eyes.
• Yellowing of the Sclera: The whites of the eyes appear yellow.
• Dark Urine: Urine may be darker than usual.
• Pale Stools: Stools may be lighter in colour.
• Poor Feeding: The baby may have difficulty feeding.
• Lethargy: The baby may seem unusually tired or lethargic.

If any of these symptoms are observed, it's important to consult a healthcare provider for evaluation and appropriate treatment.

Diagnosis of Neonantal Jaundice

• Physical Examination: The healthcare provider checks for yellowing of the skin and eyes.
• Medical History: Reviewing the baby's birth history and any relevant family health issues.

Blood Tests:

• Serum Bilirubin Test: Measures the level of bilirubin in the blood.
• Complete Blood Count (CBC): To check for anemia or infection.
• Blood Type Testing: To identify potential blood group incompatibilities.
• Additional Tests: If necessary, further tests might include a direct Coombs test to check for hemolytic disease or liver function tests to assess the liver's health.

Diagnosis and management should be done by a healthcare professional to determine the underlying cause and appropriate treatment.

What is prolonged jaundice?

If jaundice lasts for 14 days or even after 14 days of birth or 21 days for premature babies, it is known as prolonged jaundice. It is mostly caused by breastfeeding and could also indicate a serious problem. A newborn may become jaundiced while being breastfed, but this is not harmful to the baby and poses no health risks.

Causes of Neonatal Jaundice

Jaundice in newborn babies may also be caused by several other causes, including blood, liver diseases like biliary atresia (obstruction of the normal flow of bile from the liver into the gut), infections, or blood group incompatibility, which is caused by the reaction of the mother's blood group with the baby's blood group, which destroys red blood cells in the baby.

• Jaundice in the first 24 hours may not be physiological jaundice.
• Consult a paediatrician if the baby shows jaundice or seems unwell.
• A paediatrician usually performs a checkup after 72 hours of birth.
• Immediate consultation is needed if jaundice appears within 24 hours, persists for 14 days, or the baby is unwell.

Tests for Neonatal Jaundice

A transcutaneous bilirubinometer is used to measure the level of bilirubin. It is placed against the baby's skin and is used for babies who are 24 hours old and above 35 weeks. If there is prolonged jaundice or jaundice in the first 24 hours, the baby's unwell should be seen by a Paediatrician, and other tests may be recommended, like further blood tests, ultrasound scans, and tests for any infections.

Treatment for Neonatal Jaundice

Fluid intake should be increased for babies with jaundice. Phototherapy and exchange transfusion could be the treatment options.

• Phototherapy uses light to lower bilirubin levels by converting it into harmless substances.
• It's the primary treatment for high bilirubin in babies.
• Monitored with a bilirubin chart, it's safe and effective.
• Limits holding time; eye protection is provided.
• Starts promptly for premature babies or jaundice within 24 hours of birth.
• If bilirubin levels are too high, an exchange transfusion, which involves blood transfusion to decrease the level of bilirubin, is needed.
• Other treatments may also be needed if there is any other underlying cause.

Prognosis Neonatal Jaundice

For breastfeeding jaundice and physiological jaundice, the prognosis is excellent without any other long-term problems. The prognosis could also differ depending on the seriousness of the cause of jaundice.

Frequently Asked Questions