Neonatal jaundice is one of the most common ailments among children affecting almost 60% of babies in the first week of their lives. It is caused by excess of bilirubin in the body. A bilirubin level of more than 5mg/dl is considered jaundice among neonates. The symptoms include yellowing of white part of eyes and skin.
The yellow discoloration of sclera and skin is caused by the accumulation of a pigment known as Bilirubin in the blood. The pigment Bilirubin is formed in the body when body breaks down old red blood cells as a part of regeneration of new blood cells. The liver usually clears the bilirubin from the blood.
Neonatal Jaundice occurs because of a normal increase in the breakdown of RBC and because the immature livers of babies are not able to process and remove bilirubin from the blood stream.
Symptoms of Jaundice In Newborns
Jaundice generally occurs at 2 to 4 days of age and vanishes by 1 to 2 weeks of age. Usually the signs of jaundice are: yellowing of the skin, yellowing of the eyes
The yellow discoloration is first seen on baby’s face and then if the condition continues then you will see it extending down the body from chest and limbs to the lower parts of the body.
A simple way to check about jaundice in a new born baby is to press gently her forehead or nose. If it looks yellow after pressing then the chances are that the baby has jaundice but if looks slightly pale from original complexion for a moment and then bounces back to original complexion then the chances are that the baby is fine and has not got jaundice. This simple examination for jaundice should be done in the natural daylight.
The worrisome signs of jaundice include if:
• The baby gets affected by jaundice within 24 hours of birth.
• Gets affected by jaundice after 10 days of birth
• The baby is sleepy more than usual
• The baby cannot feed well despite latching well with the breast or bottle
• The baby passes pale colored stools or unusually dark urine which leaves stains on diapers and clothes
Most of the babies get affected by physiological jaundice. Physiological jaundice is the condition when the rate of RBC break down is more than its processing and removal by the liver. It is not a disease but a stage of baby’s development and hence is not threatening per se. This kind of jaundice is the commonest among kids and it gets normal as the liver becomes active and mostly vanishes by the time the baby becomes 10 days old.
There are many other causes also. Bruising during the process of birthing can cause jaundice because after bruising more number of RBCs break down, producing more of bilirubin while the liver is unable to process them at a compatible fast rate. Similarly, If the baby swallows her mother’s or her own blood during delivery then also a similar situation occurs. Besides, infection and some other ailments can also cause jaundice.
If the mother’s blood group is different from her baby then in the absence of right medication her antibodies can attack and kill baby’s cells causing jaundice. A diabetic mother can also cause jaundice to her neonate. Children affected with Polycythemia are also prone to have jaundice. Polycythemia is a condition in which the baby is born with excess amount of RBCs in the body.
Hormone deficiencies in the baby like hypothyroidism or hypopituitarism can also cause jaundice among infants. Sometimes there are some genetic factors involved like low production or other problems with the enzymes that break down bilirubin in the body. These include rare conditions like Crigler-Najjar syndrome, Gilbert’s syndrome, etc.
Sometimes a condition of liver called biliary atresia causes jaundice. In this condition, the tubes that drain bile from the liver are choked. This condition can be resolved through a surgery, provided there is an early detection of the problem.
Risk Factors of Jaundice In Newborns
Premature Birth of the Baby
The liver of a premature baby will not be able to process the bilirubin from the blood at the same rate as that of a full term baby and hence is prone to jaundice.
Breast fed babies are more prone to have jaundice, especially those who are not able to feed well through breast feeding.
Incompatible Blood Groups
If mother’s blood group is different from baby then the baby may have received antibodies through placenta which can cause her RBCs to break down quickly.
If severe jaundice is left untreated, it can cause serious and life threatening complications in the baby.
Acute Bilirubin Encephalopathy
If the levels of bilirubin are extremely high then there are chances of its reaching into the brain cells. Since bilirubin is poisonous for brain’s cells it can cause severe and permanent damage to the baby. However, prompt action can stop any kind of permanent and significant damage.
The signs of Acute Bilirubin Encephalopathy include inactive or extremely sleepy baby, poor feeding, crying loudly than usual, Fever and backward arching of neck and body.
Kernicterus occurs at the advanced stage of Acute Bilirubin Encephalopathy when the disease has Already done damage to the brain of the baby. Kernicterus can cause permanent and significant damage to the baby like uncontrolled movements in the baby, permanent upward gaze, hearing loss and intellectual impairment. However, because of increased awareness and availability of effective treatments these conditions are extremely rare these days.
Tests and Diagnosis
First of all the doctor will diagnose neonatal jaundice on the basis of the baby’s appearance. This is a reliable test for judging presence of jaundice but it cannot reveal the severity of the disease. For this, the doctor will measure the level of bilirubin in the baby’s blood. The level of bilirubin will determine the type of treatment for the baby.
Physical examination, lab test of baby’s blood and skin test with a device called transcutaneous bilirubinometer determine jaundice in a baby. The doctor may conduct additional tests if he suspects that there is some other underlying cause of jaundice in the baby.
Treatments for Jaundice In Newborns
Under this therapy, the baby is placed under special lights that emit light in blue – green spectrum. The lights change the structure of bilirubin which helps in excreting it out of the body through urine and stool.
If the jaundice is caused by differences of blood groups between mother and baby then the doctor conducts intravenous immunoglobulin transfusion. Immunoglobulin is a kind of blood protein that helps in reducing levels of antibodies and help in decreasing jaundice.
Exchange Blood Transfusion
Sometimes, when other treatments do not work with the baby then an exchange transfusion of blood is conducted. This procedure involves frequently withdrawing small amounts of baby’s blood, diluting the bilirubin and antibodies, and finally transferring the same blood back into the baby.
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