Newborn Jaundice

Newborn jaundice is when a baby has high levels of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool. High levels of bilirubin make your baby's skin and whites of the eyes look yellow. This is called jaundice. Jaundice in newborns most commonly occurs because their livers are not mature enough to remove bilirubin from the blood. Jaundice may also be caused by a number of other medical conditions.

Physiologic jaundice is the most common form of newborn jaundice. When the baby is growing in the mother's womb, the placenta removes bilirubin from the baby's body. The placenta is the organ that grows during pregnancy to feed the baby. After birth, the baby's liver starts doing this job. This can take a while. The baby's liver plays the most important part in bilirubin breakdown. The type of bilirubin that causes the yellow discoloration of jaundice is called unconjugated or indirect bilirubin. This form of bilirubin is not easily removed from the baby's body. The baby's liver changes this unconjugated bilirubin into conjugated or direct bilirubin, which is easier to excrete. The liver of a newborn baby is immature, so the job of conjugating and removing bilirubin is not done completely well. This causes an elevation of bilirubin, which results in the yellow discoloration of the baby's eyes skin. As the breakdown of red blood cells slows down, and the baby's liver matures, the jaundice rapidly disappears. When jaundice is due to these factors alone, it is termed physiologic jaundice.

Neonatal jaundice can be seen in cases of maternal-fetal blood type incompatibility. The mother's body will actually produce antibodies that attack the fetus's blood cells. This causes a breakdown of the red blood cells and thus an increased release of bilirubin from the red cells.

Healthy red blood cells can be destroyed in a condition called hemolysis.

Polycythemia is a condition in which a child is born with an excess of red blood cells.

A large scalp bruise called a cephalahematoma can occur during the birthing process. Such a bruise is really a collection of clotted blood just beneath the skin surface. As the body naturally breaks down this clotted blood, a large amount of bilirubin is released at once. This sudden excess in serum bilirubin may be too much for the baby's liver to handle, and jaundice will develop.

Sometimes a baby swallows blood during birth. This swallowed blood is broken down in the baby's intestines and absorbed into the bloodstream. Just as the excess blood from a blood clot will cause a rise in serum bilirubin, so will this.

A mother who has diabetes may cause a baby to develop neonatal jaundice.

Crigler-Najjar syndrome and Lucey-Driscoll syndrome are also conditions that can cause jaundice.

Symptoms

Jaundice causes a yellow color of the skin. The color sometimes begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.Sometimes, infants with significant jaundice have extreme tiredness and poor feeding.

Signs and tests

Doctors, nurses, and family members will watch for signs of jaundice at the hospital, and after the newborn go home.

Any infant who appears jaundiced should have bilirubin levels measured right away. This can be done with a blood test.

Many hospitals check total bilirubin levels on all babies at about 24 hours of age. Hospitals use probes that can estimate the bilirubin level just by touching the skin. High readings need to be confirmed with blood tests.

Tests that will likely be done include:

a)        Complete blood count

b)       'Coomb's' test

c)        'Reticulocyte' count

Further testing may be needed for babies who need treatment or whose total bilirubin levels are rising more quickly than expected.

          

Treatment

 Treatment is usually not needed.

When determining treatment, the doctor must consider:

a) The baby's bilirubin level

b) How fast the level has been rising

c) Whether the baby was born early (babies born early are more likely to be treated at lower bilirubin levels)

d) How old the baby is now

Your child will need treatment if the bilirubin level is too high or is rising too quickly.

Keep the baby well hydrated with breast milk or formula. Frequent feedings (up to 12 times a day) encourage frequent bowel movements, which help remove bilirubin through the stools. Ask your doctor before giving your newborn extra formula.

Some newborns need to be treated before they leave the hospital. Others may need to go back to the hospital when they are a few days old. Treatment in the hospital usually lasts 1 to 2 days.

PHOTO THERAPY

photo-therapy

Sometimes special blue lights are used on infants whose levels are very high. This is called phototherapy. These lights work by helping to break down bilirubin in the skin.

The infant is placed under artificial light in a warm, enclosed bed to maintain constant temperature. The baby will wear only a diaper and special eye shades to protect the eyes. The American Academy of Pediatrics recommends that breastfeeding be continued through phototherapy, if possible. Rarely, the baby may have an intravenous (IV) line to deliver fluids.

If the bilirubin level is not too high or is not rising quickly, you can do phototherapy at home with a fiberoptic blanket, which has tiny bright lights in it. You may also use a bed that shines light up from the mattress.

a) You must keep the light therapy on your child's skin and feed your child every 2 to 3 hours (10 to 12 times a day).

b)  A nurse will come to your home to teach you how to use the blanket or bed, and to check on your child.

c)  The nurse will return daily to check your child's weight, feedings, skin, and bilirubin levels.

d)  You will be asked to count the number of wet and dirty diapers.

In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby's blood is replaced with fresh blood. Treating severely jaundiced babies with intravenous immunoglobulin may also be very effective at reducing bilirubin levels