Did you know that almost 60 percent of all newborn babies develop jaundice?
Jaundice is one of the common symptoms to watch out for after giving birth to an infant. The Centers for Disease Control and Prevention defines neonatal jaundice as the yellowish discoloration seen in the skin of neonates or newborn babies. Jaundice can also be noticed on the white portion (sclera) of the eye, and the yellow color usually starts from the face and spreads in the baby’s body through a downward direction. The discoloration peaks at around 3 to 5 days after birth.
Jaundice is not a disease but is a manifestation of a condition called hyperbilirubinemia. If left untreated, this condition can lead to a serious complication in the brain termed kernicterus, which can further lead to debilitating effects in the baby’s visual, auditory and intellectual development.
Why Does Jaundice Occur In Newborns?
Jaundice is a symptom of hyperbilirubinemia – hyper (meaning high), bilirubin (a chemical by-product within the body) and emia (presence in the blood). In short, your newly born baby becomes yellowish due to the build-up of high levels of bilirubin in the bloodstream. But why is it a common condition that occurs among newborns?
When the mother is still pregnant, her liver is the one taking care of removing the bilirubin in the baby’s blood. However, upon birth, this “job” is passed on to the baby’s own liver. Many among them have young livers which may get too overwhelmed with the sudden transition and would take time to fully work out the excretion process. This will result in a high concentration of bilirubin in the bloodstream which is evident as a yellow discoloration in the baby’s eyes and skin. This is also referred to as physiologic jaundice.
Though physiologic jaundice is the most common cause among newborns, any other underlying cause that results in the build-up of bilirubin in the bloodstream will also lead to jaundice.
What Is Bilirubin And Why Does It Need To Get Out Of The Body?
Bilirubin mostly results from the normal process of breaking down Hemoglobin in the blood. Normally, bilirubin should bind with a protein component called albumin for it to be transported to the liver. This combination will result in “conjugated bilirubin”.
The liver has a special enzyme called uridine diphosphogluconurate glucuronosyltransferase (UGT) which converts this conjugated bilirubin to become water-soluble so it could be easily excreted. The water-soluble bilirubin is then transferred to the small intestine through the bile. The intestines have bacteria which will further break it down to urobile that can be moved out of the body through the feces or stool.
The intestinal tract also has an enzyme called β-glucuronidase which converts some of them into “unconjugated bilirubin”. This unconjugated or plain form of bilirubin will be reabsorbed through the bloodstream. This is referred to as the enterohepatic circulation of bilirubin (entero- intestines, hepatic- liver).
Hence, bilirubin is a waste product and what we have talked about is the normal physiology regarding its excretion. A sufficient amount of bilirubin needs to be moved out of the body to avoid its build up on the bloodstream. Should there be any circumstance hindering this normal process, it will cause systemic effects that are more likely to be debilitating in the long run.
What Are Some Other Causes Of Neonatal Jaundice?
As mentioned earlier, any condition that can lead to bilirubin build up in the blood will produce jaundice. So aside from the most common reason which is the physiologic hyperbilirubinemia, here are some other causes of jaundice in newborns:
Ineffective breastfeeding. The decreased breast milk consumption will result to dehydration, less stool, and thus, less excretion of bilirubin. It affects around 1/6 of breastfed babies within one week of age.
Breast milk. Though this cause is less common, jaundice has been attributed to some breast milk variety with high concentrations of the enzyme β-glucuronidase. This is the enzyme similar to the one found in the intestinal tract and has a vital role of converting the bilirubin back to its unconjugated variety. In this case, jaundice is commonly noticed in day 5 to 7 and peaks at about two weeks of age.
Pathologic hyperbilirubinemia. Jaundice can also be caused by an underlying pathologic disease such as hemolytic anemia, G6PD deficiency, Hematoma resorption, sepsis, and hypothyroidism.
If the yellowish discoloration appears during the first 24 to 48 hours (1 to 2 days), or that it persists for longer than two weeks, jaundice is most likely to be of pathological origin. This is more serious and will need prompt medical assessment and intervention.
Diagnosis And Treatment Of Neonatal Jaundice (Hyperbilirubinemia)
Upon the manifestation of jaundice in newborns, doctors can confirm hyperbilirubinemia by means of TcB and TSB.
TcB or Transcutaneous Bilirubin is measured by placing a light meter on the baby’s head. It is a non-invasive diagnostic method. If the result shows high bilirubin levels, then the doctor would often request for a blood test.
TSB or Total Serum Bilirubin is the most accurate method of diagnosing hyperbilirubinemia. The “heel stick” technique is utilized to get a small blood sample from the baby’s heel. Treatment will usually be recommended if the results yield high levels of TSB, considering the age of the infant and other risk factors associated with the condition.
The CDC states that the goal of the treatment is to eradicate brain damage due to untreated jaundice.
There are two treatment options for neonatal jaundice: phototherapy and exchange transfusion.
Phototherapy is the more popular treatment option to lower bilirubin levels in newborn babies. It involves the use of “bili light” which helps break down the bilirubin into its water-soluble form to be excreted easily. During phototherapy, the baby will be undressed with only the diapers on. Special films will be provided to cover the eyes and the genitals. He will then be placed in a crib, under the special light, for certain periods of time. Depending upon the availability of equipment, this procedure can be done in the hospital setting or in your own home.
TSB will be routinely checked to evaluate the effectiveness of phototherapy. Should the levels remain high, exchange transfusion is more likely to be advised.
Exchange transfusion is the treatment option recommended for serious cases of hyperbilirubinemia. It involves withdrawing and replacing small amounts of blood through a catheter placed in the baby’s umbilical vein to rapidly remove bilirubin from the bloodstream.
Together with the aforementioned treatments, it will also be necessary to increase your baby’s milk consumption to help facilitate the excretion process through the baby’s stool.
What Should Parents Do?
1. Be aware.
Some babies who are more at risk than others:
- Premature babies
- Those with darker complexion (jaundice is less noticeable)
- Those with siblings who also had neonatal jaundice
- Those with feeding difficulties
- Babies with hematoma or bruise upon birth
- Babies of Mediterranean or East Asian descent (where G6PD deficiency is more common)
- A baby born to a mother who has O blood type or Rh negative blood factor (blood incompatibility will yield hyperbilirubinemia in the neonate)
2. Ask your doctor about the jaundice bilirubin tests.
3. Schedule a follow-up plan before leaving the hospital.
Usually, you and your baby will be advised for a check-up within three to five days after giving birth, to check for jaundice.
4. Observe your infant for signs indicating medical help.
The CDC recommends the need to see your pediatrician the same day if your baby:
- Has very evident yellowish or orange skin discoloration that starts from the head and spreads to the toes
- Has difficulty sleeping or waking up
- Is not sucking well
- Becomes very irritable
- Is not having enough wet /dirty diapers
Emergency medical help should be sought if:
- Your baby cries inconsolably or with a high tone.
- The baby’s body is arched forward while the head, neck, and heels are bent backward.
- The body of your newborn becomes stiff, limp, or floppy.
- The baby’s eyes make strange movements.
Neonatal jaundice is a condition that should be taken seriously. Parents need to be extra vigilant upon noticing the first manifestation of the condition and seek help when needed. With prompt assessment and medical intervention, its debilitating complications can be avoided.
This article is for informational purposes only and should not be considered medical advice. Always consult with a doctor or licensed medical professional before making any medical decisions.