Neonatal Jaundice

Neonatal jaundice commonly affects pre-term babies born before 38 weeks. A Baby's blood contains excess bilirubin, the yellow pigment of the red blood cells, and jaundice results from the increased serum bilirubin levels. Around 60% to 80% of premature babies develop jaundice, but only 10% of babies show severe signs of jaundice.  

Symptoms

Yellow discolouration of the skin and eyes is the main sign of jaundice. This discolouration usually appears between the second and fourth days.

How to check for jaundice in infants

Use the index finger and gently press on the forehead or nose to check for a yellow appearance. In case of jaundice, you will notice a mild yellow discolouration. In normal babies, the skin will appear white on pressing gently with the finger.

When to visit the doctor

Usually, babies are checked for jaundice in the hospital immediately after birth. The bilirubin levels spike between the third and fourth days. If your baby is discharged earlier than 72 hours, schedule an appointment to check for the possibility of the development of jaundice.

Visit your doctor or schedule an appointment if:

• Yellow discoloration of eyes and skin increases
• The baby is feeding poorly and not gaining weight over time
• The baby is sick and always sleeping

Causes

Newborn babies produce extra red blood cells. The breakdown of used red blood cells produces bilirubin. Excess production of bilirubin is the leading cause of jaundice. Usually, bilirubin is filtered out through the body by the liver into the bloodstream and excreted via the intestinal tract. However, newborn babies have immature livers and cannot process the excess bilirubin, which leads to jaundice.

Other factors also cause neonatal jaundice. In these cases of neonatal jaundice, the symptoms are usually seen at a later stage.

• Blood infection (sepsis)
• Enzyme deficiency
• The infant's blood group is different from the mother's
• Abnormality of the red blood cells leads to an increase in early cell breakdown
• Bacterial and viral infections
• Malfunction of the liver

Risk factors

1. Pre-term birth

A premature baby born 38 weeks of pregnancy cannot efficiently process bilirubin. These babies feed less and therefore process less bilirubin, leading to the development of jaundice.

2. Blood type

The baby receives antibodies from the mother's placenta. If the baby has a different blood type than the mother, the acquired antibodies cause an increase in the breakdown of red blood cells, increasing the bilirubin levels in the body.

3. Injury or bruising during birth:

Bruising during delivery causes a higher breakdown of the red blood cells, which leads to jaundice.

Complications

1. Acute bilirubin encephalopathy

A high level of bilirubin is toxic to the brain. Immediate and effective treatment is required in this case to avoid lasting damage to the brain.

Signs of acute bilirubin encephalopathy are

• Decreased frequency of feeding and poor sucking capability.
• Fever
• Always sleepy and having difficulty waking
• High-pitched crying

2. Kernicterus

It is a syndrome that causes permanent brain damage. Kernicterus causes:

• Hearing loss
• Deformity of the tooth enamel
• Uncontrolled and involuntary movements

Diagnosis

1. Physical examination

Examination of the skin and eye for yellow discolouration.

2. Blood and urine analysis

Complete blood count, RH factor incompatibility, and blood group testing. A special test to evaluate the increased red blood cell breakdown.

3. A skin test using a bilirubin meter

Treatment:

Treatment of neonatal jaundice depends on the severity. Mild jaundice generally resolves on its own within 2-3 weeks. Voluntary treatment is given in the case of moderate to severe jaundice.

1. Frequent feeding

The doctor will advise improving the baby's nutrition by increasing the feeding frequency. This is mainly done to prevent weight loss.

2. Phototherapy

The baby is placed in a specialized chamber with blue-green light. This light alters the shape and size of the bilirubin molecules, making their excretion by the urine and stool easy.

3. IV immunoglobulins

Babies with a different blood group than the mother have circulating antibodies that cause an excessive breakdown of red blood cells leading to increased bilirubin levels. Immunoglobulins are proteins that decrease the rate of red blood cell breakdown, thereby decreasing bilirubin production.

4. Blood transfusion

This is done in severe cases of jaundice when no other treatment is effective. A small amount of the baby's blood is replaced with blood containing less bilirubin.

Neonatal jaundice is fatal if left untreated but can easily be avoided with prior knowledge of the medical condition. Special care and attention should be given to premature babies. Frequently nursing the baby to improve and maintain the baby's nutrition helps to avoid jaundice.

Request an appointment at Apollo Cradle, Amritsar - Abadi Court Road. Call 1860-500-4424 to book an appointment.