Neonatal Jaundice

Neonatal Jaundice

Jaundice is a common condition encountered in newborns. It can be a source of stress for new parents. Here is a series of few questions and answers which will provide you useful information to help alleviate some anxiety and misconceptions :

What is Jaundice ?

Jaundice is yellowish discolouration of skin and /or whites of the eyes. It results from elevation of yellow pigment “bilirubin” in the blood.

Why does Jaundice occur in newborns?

Bilirubin is produced as a byproduct of breakdown of red blood cell in the body. Normally, it passes through the liver from where it is processed and secreted as bile. Jaundice happens when bilirubin builds up faster than a newborn’s liver can break it down and pass it from the body. Here are some reasons why:

  • Newborns make more bilirubin than adults do since they have more turnover of red blood cells.
  • A newborn baby’s still-developing liver might not be able to remove enough bilirubin from the blood.
  • A baby’s intestines absorb bilirubin that would normally leave the body in the stool (poop).

How many of newborns will get Jaundice?

As many as 85% of term newborns and most of the Preterm neonates develop clinical jaundice. But only 5-6% required some treatment.

How does Jaundice affect my baby?

Jaundice does not cause pain to the baby. It is self limiting in most cases but severe jaundice when not treated timely has the potential to cause permanent damage to the brain of the newborn and cause deafness and cerebral palsy.

How does jaundice progress and how can I check for it?

Jaundice initially causes the skin to become yellowed. Later, the whites of the eyes may have a yellowish tinge. These changes may be hard to recognize in children with a dark skin color or if a baby is unable to open eyelids. The color change is noticeable in the face first, and may progress down the chest, abdomen, arms, and then finally the legs.

It can be checked by pressing one finger on your baby’s forehead or nose. If the skin is jaundiced, it will appear yellow when you release pressure from the skin.Can be tracked in some babies by pressing over the bony prominences of the chest, hips, and knees to check if the jaundice is progressing.

Are some babies have higher risk for jaundice?

Yes, some babies do have a higher risk:

  • Babies born preterm(before 37 weeks)
  • Babies bruised during birth
  • Babies whose siblings had jaundice
  • Babies whose mothers are Rh negative and / or have Type O blood group
  • Babies with Middle Eastern, Mediterranean, or East Asian ethnicity

What are the Red flag signs for a jaundiced baby?

Signs of worsening jaundice — Contact your child’s Paediatrician if you notice any of the following:

  • If the yellow coloring is at the knee or lower, if the yellow color is more intense (lemon yellow to orange yellow), or if the “whites” of the eyes appear yellow
  • If the baby has any difficulty in feeding
  • If it is hard to wake up your infant
  • If your infant is irritable and is difficult to console
  • If your infant arches his/her neck or body backwards
  • your baby has a fever over 100°F (37.8°C)
  • your baby has jaundice during the first 24 hours of life

How is the baby tested for jaundice?

Generally, your pediatrician will examine your baby to pick up jaundice. Following which he can opt for a blood test to ascertain the severity of jaundice.

What is the relation between breastfeeding and jaundice?

Jaundice is common in infants who are breastfed because of two different reasons:

  • Breastfeeding failure occurs in infants with inadequate intake of breast milk because of difficulty in feeding or if the mother does not have an adequate milk supply. These infants lose a large amount of weight, thereby increasing bilirubin concentrations. Increasing the mother’s milk supply, frequent feeding, and ensuring good sucking (latch) are the best treatments for inadequate intake jaundice.
  • Breast milk jaundice is thought to be due to the infant’s immature liver and intestines. It typically begins the first week after birth, peaks within two weeks after birth, and declines over the next few weeks. Breast milk jaundice is not a reason to stop breastfeeding as long as the baby is feeding well, gaining weight, and otherwise thriving. Infants with breast milk jaundice rarely need treatment unless severe hyperbilirubinemia develops.

How is Jaundice treated?

The goal of jaundice treatment is to quickly and safely reduce the level of bilirubin. Infants with mild jaundice may need no treatment. Infants with higher bilirubin levels or hyperbilirubinemia will require treatment, which is described below:

  • Encourage feeding— Providing adequate breast milk or formula is an important part of preventing and treating jaundice because it promotes elimination of the yellow pigment in stools and urine. You will know that your child is getting enough milk or formula if s/he has at least six wet diapers per day, the color of the bowel movements changes from dark green to yellow, and s/he seems satisfied after feeding.
  • Phototherapy— Phototherapy (“light” therapy) is the most common medical treatment for jaundice in newborns. In most cases, phototherapy is the only treatment required. It consists of exposing an infant’s skin to blue light, which breaks bilirubin down into parts that are easier to eliminate in the stool and urine. Treatment with phototherapy using special blue lights, such as blue light-emitting diodes (LEDs), is successful for almost all infants.Keeping the baby in direct sunlight is of no use and might actually result in sun burn.

When do the Bilirubin values peak?

In a term baby bilirubin peaks around 4 – 5 th day of life and returns to normal by 14 days. For a preterm baby peak occurs on 7-8th day of life and values return to normal by 21 days. Your visit to your Paediatrician are planned accordingly.

What is prolonged Jaundice and when does it occur?

Jaundice persisting beyond 2 weeks in a term and beyond 3 weeks in a preterm baby is prolonged jaundice. It can occur due to variety of reasons like hypothyroidism, breast milk jaundice etc. You must contact your pediatrician for the same.

Dr. Jaskaran Singh Sawhney
Paediatric & Neonatology
Motherhood Chaitanya Hospital Chandigarh

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