Jaundice in Newborns : Know The Causes, Prevention & Treatment

In newborn infants, jaundice is prevalent and typically not harmful. As a result, the skin and eye whites turn yellow. The medical term for newborn jaundice is neonatal jaundice.

Bilirubin builds up in your baby's blood and causes jaundice. 

When red blood cells degrade, your body produces bilirubin, which is yellow. Baby jaundice is a yellow discolouration of the skin and eyes of a newborn child. Baby jaundice develops when the baby's blood has an excessive amount of bilirubin, a red blood cell pigment that is yellow.

Baby jaundice is a frequent illness, especially in premature infants (babies born before 38 weeks of pregnancy) and in breastfed infants. When a baby's liver is not developed enough to eliminate bilirubin from circulation, infant jaundice frequently develops. Some newborns' jaundice may be caused by an underlying ailment.

The majority of babies delivered between 35 weeks of pregnancy and full term do not require treatment for jaundice. Occasionally, particularly when specific risk factors for severe jaundice are present, an exceptionally high blood level of bilirubin might put a baby at risk of brain damage.

Causes

Bilirubin accumulation in the baby’s blood is the primary cause of jaundice in newborns. This disorder is known medically as hyperbilirubinemia. The breakdown of red blood cells, which transport oxygen throughout the body, results in the production of bilirubin, a yellow material.

As newborns have a large number of red blood cells in their blood that are constantly being broken down and replenished, jaundice is frequently seen in them.

Additionally, because a newborn baby's liver is still developing, it is less efficient at clearing bilirubin from the blood. The liver eliminates bilirubin for the unborn child during pregnancy. However, the baby's liver needs to start eliminating bilirubin after birth. The baby's liver may not be able to eliminate bilirubin if it is not sufficiently grown. The baby's skin may appear yellow when too much bilirubin accumulates. 

A baby's liver becomes more adept at processing bilirubin by the time they are about 2 weeks old, so jaundice frequently resolves by this time without any negative effects.

Jaundice may occasionally be a symptom of an underlying medical issue.

Risk Factors

A baby may experience severe jaundice if they have:

• Blood poisoning (sepsis).
• A blood type other than your own.
• Bruises from a challenging delivery.
• Red blood cells in excess.
• A low level of oxygen (hypoxia).
• A problem with the liver, like biliary atresia.

Symptoms

Yellow–coloured skin: 

Yellow skin is the biggest symptom of jaundice in newborns.  The yellowing of the skin is usually more pronounced on the head and face. Brown or dark skin, however, could make skin whitening harder to spot.

Inside the eyes or the mouth or on the palms of the hands or the bottoms of the feet, it might be simpler to see.

The yellowing may also worsen if you push a patch of skin with your finger.

The following are other signs of neonatal jaundice:

• Pee that is dark yellow (newborn babies' urine should be colourless)
• Light-coloured or pale poop (it should be yellow or orange)
• The baby is drowsy 
• The baby does not have the desire to eat or feeds less than usual

Timing in the appearance of symptoms: 

Newborn jaundice symptoms often appear 2 days after birth and tend to subside on their own by the time the infant is about 2 weeks old.

Jaundice can take 5 to 7 days to manifest in premature babies, who are more susceptible to it, and typically lasts for 3 weeks.

Additionally, some newborns who solely receive breast milk experience it for a longer period of time.

Prevention

Newborns' jaundice is common and typically unavoidable. 

Feeding: 

By providing frequent feedings to your infant, you can lessen the chance that they will get severe jaundice. 

Frequent feedings encourage regular bowel movements, which will help your baby get rid of bilirubin.

Breastfed babies: 

Babies who are breastfed should have eight to twelve feedings each day throughout their first week of life.

Formula-fed babies:

During the first week of life, you should give your infant one to two ounces (30 to 60 millilitres) of formula every two to three hours. Make sure there are at least eight feedings per day.

Prior to leaving the hospital, ensure your baby's bilirubin level is checked by a healthcare professional. Plan a follow-up appointment for your infant's first week of life.

Treatments 

Jaundice in babies typically does not require medical attention. Jaundice that is only mildly elevated often goes away on its own as your baby's liver continues to grow. It might take up to a week.

Feeding your infant frequently (10–12 times a day) can promote defecation (bowel movements). This aids in your baby's body's removal of extra bilirubin.

The newborn baby may need to be taken to the hospital and treated with phototherapy or an exchange transfusion if their jaundice does not go better on its own or if testing reveals elevated levels of bilirubin in their blood.

Phototherapy treatment: 

A medical professional could suggest phototherapy if the baby’s bilirubin level is high or keeps rising. 

The baby will be placed in front of specialized blue lights wearing only a diaper and a mask to cover their eyes. The baby's liver can get rid of extra bilirubin with the aid of phototherapy. The baby will not be hurt by the lights. 

It will typically halt for 30 minutes so the baby can be fed, changed or cuddled. If jaundice in your newborn does not go away, increased phototherapy might be suggested. In order to do this, either use more light or combine it with another source of light, such as a light blanket.

You will not be able to nurse or hold your baby during enhanced phototherapy because the treatment cannot be interrupted for pauses. However, you can offer expressed milk to your infant.

The baby’s temperature will be watched during phototherapy to make sure they do not get too hot and their fluid levels will be examined for signs of dehydration.

If your baby is not able to consume enough fluids and is becoming dehydrated, intravenous fluids may be required. After phototherapy has begun, the bilirubin levels will be checked every 4 to 6 hours to see how well the treatment is working.

Your baby's bilirubin levels will be monitored every 6 to 12 hours once they have stabilized or begun to decline.

When treating neonatal jaundice, phototherapy is typically quite effective and rarely causes adverse consequences.

One to two days are needed for phototherapy treatment, once bilirubin levels are at a safe level. 

Exchange transfusion:

A medical professional might advise an exchange transfusion if phototherapy does not work in one of the very few instances when it does. 

A portion of your baby's blood is replaced with new, donated blood during an exchange transfusion.

During an exchange transfusion, a tiny plastic tube will be inserted into blood vessels in your baby's arms, legs, or umbilical cord to remove blood. Within two hours of the treatment, blood will be drawn from the newborn to determine whether it was successful. The operation might have to be repeated if your baby's blood bilirubin level continues to be excessive.

The overall level of bilirubin in your baby's blood will drop soon since the new blood will not have any bilirubin in it.

Throughout the transfusion procedure, which might take many hours to complete, your infant will be carefully watched. Any potential issues, such as bleeding, will be managed.

Treating underlying conditions: 

Jaundice usually needs to be treated if it is brought on by an underlying medical condition, like an infection.

Intravenous immunoglobulin (IVIG) may be utilized if the jaundice is brought on by rhesus illness (when the mother has rhesus-negative blood and the newborn has rhesus-positive blood).

IVIG is typically only used when phototherapy has failed and the blood bilirubin level is steadily increasing.

Contact a healthcare professional if the baby's condition worsens or does not improve after two weeks.

Complications of Jaundice in Newborns

Standard procedure: 

Within 72 hours of birth, your baby will typically undergo a newborn physical examination as part of which any symptoms of jaundice will be screened for.

After this point, get help from your doctor, as soon as you can if your infant exhibits any symptoms of jaundice.

Jaundice is typically not dangerous and does not indicate any underlying health issues.

By the time a baby is two weeks old, it typically goes away on its own.

Even though jaundice is typically not a problem, you should still consider whether your infant requires therapy.

When to ask for more professional help: 

If your infant has any of the following, call medical assistance or proceed to the closest emergency room:

• Loudly crying 
• Fever.
• Arched posture (body forward, heels or head/neck bent back).
• Floppy, limp, or stiff physique.

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