Clear The Yellow: All You Need To Know About Neonatal Jaundice

The joy of every mother after delivery of the child is to embrace and cuddle her child in her arms. A medical condition which plagues these newborn babies and threatens their lives is jaundice.

Jaundice is basically a condition in which the skin and sclera (whites of the eyes) are yellowish in color, within a few days after birth.

  • What causes neonatal jaundice?

Neonatal jaundice or jaundice in the newborn is caused by increased levels of bilirubin in the bloodstream which is deposited in the skin and sclera of the eyes.

Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells that carries oxygen) is broken down as part of the normal process of recycling old or damaged red blood cells.

  • How is bilirubin metabolized?

Bilirubin is metabolized in the liver so it can be excreted out of the liver as part of bile (the digestive fluid produced by the liver). Bilirubin is metabolized in the liver by a process called conjugation. This involves attaching a chemical substance to bilirubin.

Processed bilirubin in the bile is called conjugated bilirubin.

Unprocessed bilirubin is called unconjugated bilirubin.

  • How is bilirubin excreted?

Bilirubin is excreted through transport from the bile ducts into the small intestine (duodenum). It is further acted on by intestinal microbes where it is excreted with stool or reabsorbed into the bloodstream and excreted with urine.

  • What are the causes of neonatal jaundice?

The common causes are as follows:

  1. Physiologic jaundice: This occurs because the red blood cells in the newborn breaks down faster than in older infants. This leads to increased bilirubin production. The other reason, is the liver of the newborn is immature and cannot process bilirubin and excrete it as compared to older infants.

Newborns who present with this cause of jaundice are mostly healthy and it resolves within a week. If it persists at 2 weeks of age, consult a doctor.

  1. Breastfeeding: This involves two forms, breastfeeding jaundice and breast milk jaundice. Breastfeeding jaundice occurs in newborns who do not consume enough breast milk. It also occurs in newborns having fewer bowel movements and hence eliminate less bilirubin.

Breast milk jaundice occurs due to substances present in the breast milk that interfere with the liver getting rid of bilirubin from the body of the newborn. It is encouraged to still feed the newborn with breast milk as this would resolve after 2 weeks of age or when the newborn is being weaned.

  1. Excessive breakdown of red blood cells: This can overwhelm the newborn’s liver with more bilirubin than it can process. This is grouped into immune disorders and non-immune disorders. Immune disorders include Rh incompatibility and ABO incompatibility. Non-immune disorders include G6PD deficiency and hereditary red blood cell disorders such as alpha-thalassemia.

Other causes include infections, hypothyroidism, hypopituitarism, some hereditary disorders such as cystic fibrosis, Dubin-Johnson syndrome, Rotor syndrome, Crigler-Najjar syndrome and Gilbert syndrome.

  • What are the symptoms of newborn jaundice?

Excess bilirubin in the newborn causes yellowish discoloration of the skin and eyes. Jaundice first appears in the newborn’s face, particularly noticeable in the eyes. The yellowish color becomes evident on the entire body of the newborn as the bilirubin levels increase.

There is presence of sleepiness, difficulty waking up for feeds and lethargy when bilirubin levels are severely elevated.

  • How is neonatal jaundice treated?

Most cases of jaundice disappear within 1 to 2 weeks. However, your doctor will decide whether your baby should wait it out or start treatments such as:

  1. Extra feeding: Intake of more breast milk or formula will aid your baby to defecate more often. This will help clear out bilirubin from the baby.
  1. Phototherapy: In this treatment, the doctor puts your baby under blue-green lights. This helps bilirubin leave the baby’s body via the urine. The newborn only wears a diaper so most of the skin is exposed to the light. Eye patches are worn on the newborn’s eyes to protect them.
  1. Exchange blood transfusion: If the newborn has severe jaundice that is not getting better with other methods, a blood transfusion called an exchange transfusion is required. In this process, the doctor draws small amounts of your baby’s blood and replaces it with blood from a donor, preferably the mother. The newborn will need to stay in the neonatal intensive care unit (NICU) for the procedure.
  • How can neonatal jaundice be prevented?

There isn’t much one can do to prevent typical jaundice in newborns. However, it can be improved by ensuring the baby is well fed. Breastfeeding should be aimed at 8-12 feedings a day in the first days of the newborn’s life. If formula feeding is being used, aim for 1-2 ounces every 2-3 hours.

  • What can occur if neonatal jaundice is not treated?

Significant elevation of bilirubin levels leads to accumulation of bilirubin in the brain. This leads to a condition known as Bilirubin Induced Neurological Dysfunction (BIND), popularly known as Kernicterus. This leads to significant brain injury resulting in developmental delay, cerebral palsy, hearing loss, seizures and even death.