Neonatal Jaundice: Causes, Symptoms & Treatment for Newborns

Neonatal jaundice is a common condition in newborns, characterized by a yellowish discoloration of the skin and the whites of the eyes. This occurs due to elevated levels of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. In newborns, the liver is not yet mature enough to efficiently process and eliminate bilirubin, leading to its accumulation in the body.

Understanding Neonatal Jaundice

The term "neonatal" pertains to newborns, specifically the first 28 days after birth. During this period, infants undergo numerous physiological changes as they adapt to life outside the womb. One such change involves the breakdown of fetal hemoglobin and the subsequent production of bilirubin. While some degree of jaundice is normal in newborns, it's essential to monitor bilirubin levels to ensure they don't reach dangerous levels.

Causes of Neonatal Jaundice

Several factors can contribute to the development of jaundice in newborns:

Physiological Jaundice: This is the most common type and typically appears between the second and fourth days after birth. It results from the baby's liver maturing and becoming more efficient at processing bilirubin. As the liver develops, it starts to get rid of excess bilirubin, and the jaundice usually resolves on its own within two weeks.
Breastfeeding Jaundice: Occurs when a newborn doesn't get enough breast milk, leading to dehydration or low caloric intake, which can increase bilirubin levels. This type of jaundice may appear after your baby’s first week of life and may take a month or more to disappear.
Hemolysis: Conditions like blood group incompatibility between mother and baby can lead to increased breakdown of red blood cells, resulting in higher bilirubin production. This can cause a rapid rise in bilirubin levels within the first 24 hours after birth.
Premature Birth: Premature infants have even less developed livers, making them more susceptible to jaundice. Their bodies are less efficient at processing bilirubin, leading to its accumulation.

Symptoms of Jaundice in Newborns

The primary symptom of jaundice in newborns is a yellow discoloration of the skin and eyes. This yellowing typically starts on the face and then spreads to the chest, abdomen, arms, and legs as bilirubin levels increase. Other signs to watch for include:

Poor Feeding: The baby may have difficulty latching or show little interest in feeding.
Lethargy: Excessive sleepiness or low energy levels.
Dark Urine: Although newborn urine is usually light-colored, jaundice can cause it to appear darker.
Pale Stools: Normal baby stools are yellow or orange; pale or chalky stools can be a sign of jaundice.

If any of these symptoms are observed, it's crucial to consult a neonatologist immediately.

Diagnosis and Bilirubin Levels in Newborns

To diagnose jaundice, doctors will assess the baby's appearance and measure bilirubin levels. This can be done using a skin test with a device called a transcutaneous bilirubinometer or through a blood test. Monitoring bilirubin levels in newborns is essential to determine the severity of jaundice and the appropriate course of action.

What Is a Dangerous Level of Bilirubin in Newborns?

While mild jaundice is common and usually harmless, extremely high levels of bilirubin can be dangerous. If bilirubin levels become excessively elevated, there's a risk of bilirubin crossing into the brain tissue, leading to a condition called kernicterus, which can cause permanent brain damage. Therefore, it's vital to monitor bilirubin levels and seek medical attention if jaundice appears to worsen or if the baby exhibits any concerning symptoms.

Treatment for Neonatal Jaundice

Treatment depends on the severity of jaundice and the underlying cause. For mild cases, increased feeding can help the baby eliminate bilirubin through urine and stools. In more severe cases, treatments may include:

Phototherapy: The baby is placed under special blue spectrum lights that help break down bilirubin in the skin. This treatment is effective and commonly used for moderate to severe jaundice.
Exchange Transfusion: In critical situations, the baby's blood may be replaced with donor blood to quickly reduce bilirubin levels. This procedure is considered when phototherapy is not effective or in cases of extremely high bilirubin levels.
Intravenous Immunoglobulin (IVIg): If jaundice is due to blood group incompatibility, IVIg can reduce antibody levels, decreasing the breakdown of red blood cells.

Early detection and treatment are crucial to prevent complications.

What are the Signs of Recovery from Jaundice in Newborns

As the baby's liver matures and becomes more efficient at processing bilirubin, jaundice will typically resolve. Signs of recovery include:

Reduction in Yellowing: The skin and eyes return to their normal color.
Improved Feeding: The baby feeds regularly and gains weight.
Normal Urine and Stool Color: Urine becomes light in color, and stools are yellow or orange.

Conclusion

Newborn jaundice is a frequent occurrence, often causing new parents a bit of worry. It's characterized by a yellowish tinge to the skin and eyes, a result of bilirubin buildup as a newborn's liver gets up to speed. While mild jaundice is usually harmless and resolves naturally, it's essential to understand the signs and know when to seek help.

Most cases of jaundice are easily managed. Keep a close watch on your baby: is the yellowing spreading? Are they feeding well? Are they excessively sleepy?

If you notice any concerning signs, contact your neonatologist immediately. They can assess your baby's bilirubin levels and recommend the best course of action.

FAQ’s

Q1: My baby's skin looks a little yellow. Is that jaundice?
A: Yellow skin and the whites of the eyes are the main signs of jaundice. It's very common in newborns, but it's always best to have your baby checked by a doctor or nurse to be sure.

Q2: Is jaundice normal in newborns?
A: Yes, a mild form of jaundice is very common. It's because their livers are still getting up to speed at processing bilirubin.

Q3: How long does newborn jaundice last?
A: For most babies, it goes away within a week or two. Sometimes it can last a little longer, especially in breastfed babies.

Q4: Can jaundice hurt my baby?
A: Mild jaundice usually doesn't cause any problems. But very high levels of bilirubin can be serious, so it's important to monitor it.

Q5: How will I know if my baby's jaundice is getting worse?
A: The yellowing might spread further down the body, their urine might get darker, or they might become more sleepy and not feed well. If you notice any of these signs, call your doctor right away.

Q6: Will breastfeeding make my baby's jaundice worse?
A: Breastfeeding is actually good for babies with jaundice! It helps them poop more, which gets rid of the bilirubin. Sometimes, if a baby isn't getting enough milk, it can make jaundice last longer. Talk to your doctor or a lactation consultant if you're having trouble breastfeeding.

Q7: What can I do at home to help my baby with jaundice?
A: The most important thing is to make sure your baby is feeding well. Frequent feedings help them get rid of the bilirubin. Don't try to treat jaundice yourself without talking to a doctor.

Q8: Does sunlight help with jaundice?
A: While some sunlight can help, it's not recommended as a primary treatment. Too much sun can be harmful to a newborn's delicate skin. Phototherapy (light therapy in the hospital) is much safer and more effective.