Dr. Shalmali Satpute, MBBS & Trishtha Agarwal, 3rd MBBS
Neonatal jaundice is a common cause of mortality and morbidity in newborn babies and accounts for up to 60% of cases in term and 80% in preterm babies.
1 out of 2 babies born is diagnosed with neonatal jaundice.
WHY DOES IT HAPPEN?
Infant jaundice occurs because the baby’s blood contains an excess of bilirubin, a yellow pigment of red blood cells. It is a common condition that happens in babies before 38 weeks of gestation or also known as preterm babies. As the baby’s liver is not mature at birth to get rid of all the bilirubin it results in neonatal jaundice or it can be due to some underlying disease. An unusual level of bilirubin can place a newborn at risk of brain damage. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of “used” red blood cells.
Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life. Bilirubin is filtered from the liver and released into the intestinal tract. Jaundice because of these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day after the birth.
Other causes include:
● Internal bleeding (hemorrhage)
● An infection in your baby’s blood (sepsis)
● An incompatibility between the mother’s blood and the baby’s blood
● Other viral or bacterial infections
● A liver malfunction
● Biliary atresia, a condition in which the baby’s bile ducts are blocked or scarred
● An enzyme deficiency
● An abnormality of your baby’s red blood cells that causes them to break down rapidly
● Reduced Breast Feeding
1)Yellowing of the skin
2) White of the eyes
Both of these symptoms occur on the 2nd or 3rd day of life.
To check if your baby has jaundice or not, you can gently press his/her forehead or nose, and if the skin looks yellow where you pressed it’s likely that the baby has jaundice.
It is done by looking at the baby’s appearance, the bilirubin levels are also checked. The various methods of diagnosis are
● A physical exam
● A laboratory test of a sample of your baby’s blood
● A skin test with a device called a transcutaneous bilirubinometer, which measures the reflection of a special light shone through the skin
Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital.
Treatments to lower the level of bilirubin in the baby’s blood may include:
● Enhanced nutrition. More frequent feeding should be done to ensure the baby is getting adequate nutrition and there is no weight loss.
● Light therapy (phototherapy). The baby is placed under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in both the urine and stool. During treatment, the baby will wear only a diaper and protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or mattress.
● Intravenous immunoglobulin (IVIg). Jaundice can be related to blood type differences between mother and baby. In this condition the baby is carrying antibodies from the mother that contribute to the rapid breakdown of the baby’s blood cells. Intravenous transfusion can lessen the number of these antibodies.
- Exchange transfusion. – When the baby does not respond to other treatments , an exchange transfusion of blood is performed.
When toxic levels of bilirubin accumulate in the brain it results in a variety of symptoms and physical findings, these symptoms are lack of energy, fever , poor feeding habits and vomiting. There are also absence of reflexes such us Moro reflex ; opisthotonus in which there is mild to severe muscle spasms including those in which head and heels are bent backwards and the body bows forward; spasticity of muscles. Toxic levels of bilirubin may accumulate in certain areas of the brain (i.e., the basal ganglia and the brainstem) which result in life-threatening complications. The treatment for this includes blood transfusion. In this small amount of blood is drawn repeatedly and replaced from the donor. Another procedure is plasmapheresis where unwanted toxins are removed from the blood. In this procedure, the plasma is separated from the blood cells. The plasma is then replaced with other human plasma and the blood is transfused into the affected individual. Intense fluorescent light is focused on the bare skin, while the eyes are shielded. This helps to speed up the excretion of bilirubin from the skin and aids in its decomposition. With age body mass increases and the skin thickens due to which phototherapy becomes less effective in preventing the symptoms associated with kernicterus and hence liver transplantation should be performed.
The best way to prevent this is by adequate feeding of the breastfed infants, 8- 12 feedings a day should be given for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week.