HOW DANGEROUS IS JAUNDICE FOR NEWBORN BABIES

NEONATAL JAUNDICE

NEWBORN JAUNDICE

Jaundice is a common condition in infants, affecting more than 50 percent of newborns. In severe cases, if it is not treated properly, jaundice in a newborn baby can lead to deafness, cerebral palsy, brain damage, and even death. 60% of full-term and 80% of premature babies are estimated that develop jaundice (hyperbilirubinemia) in the first week after birth. 

Today, through this article, we will tell you what is neonatal hyperbilirubinemia or newborn jaundice, its causes, symptoms, prevention, treatment, prevention, and home remedies.

Table Of Contents 

·        What Is Newborn Jaundice?
·        Different Types Of Newborn Jaundice
·        What Are Normal Bilirubin Levels In Newborn Baby?
·        What Causes Jaundice In Newborns
·        Symptoms Of Jaundice In A Newborn
·        How Is Neonatal Jaundice Diagnosed?
·        Treatment Of Newborn Jaundice
·        Complications Of Neonatal Jaundice
·        Risk Factors Of Newborn Jaundice
·        How To Prevent Jaundice In Newborns
·        Home Remedies For Jaundice In Newborn Baby

WHAT IS NEWBORN JAUNDICE?

Infant jaundice is a condition in which a child's skin and eyes become yellow. This condition can usually be seen from the first week of childbirth. 

Newborn jaundice is a very common condition in newborns, and it occurs when children have high levels of bilirubin in their blood. It is a yellow pigment normally produced during the breakdown of red blood cells. The disease occurs when a child's liver is not sufficiently mature or ready to remove bilirubin from the bloodstream.

Jaundice affects boys more than girls in prematurely born children. Jaundice rarely affects fully mature babies born in time.

The good news is that in most cases, infant jaundice goes away after the child's liver has fully developed.

DIFFERENT TYPES OF NEWBORN JAUNDICE

There are three types of jaundice commonly found in newborns:

Physiological Jaundice: Babies suffer from Physiological Jaundice due to a high concentration of red blood cells and immature liver function. Usually, jaundice appears 2-4 days after birth and gets resolved in 1-2 weeks (3 weeks if premature). This type is not at all associated with any underlying disorders or disease.

Pathological jaundice: Jaundice is considered pathological if it develops in the first 24 hours after birth, or if the levels of bilirubin are very high from 24 hours to 10 days of age, or the baby shows signs of serious illness.

Breast milk jaundice: Breast milk jaundice is thought to be caused by an increased concentration of β-glucuronidase, an enzyme present in breast milk. This jaundice is noticed 5-7 days after birth, peaks at 14 days, and can last for a few months. Breast milk jaundice is common in breastfed babies and there is nothing to worry about it.

WHAT ARE NORMAL BILIRUBIN LEVELS IN NEWBORN BABIES?

NEWBORN JAUNDICE LEVEL

The presence of bilirubin in the blood is normal and it should be at or below 1mg/dL (milligrams per deciliter) for older children and adults.

Almost all newborn babies have elevated levels of bilirubin within 1-2 days of birth. Neonatal hyperbilirubinemia or newborn jaundice is diagnosed when blood levels of bilirubin are over 5mg/dL.
According to the American Academy of Family Physicians, bilirubin levels are below:

In healthy full-term babies, physiological jaundice usually sees bilirubin levels of about 5-6mg/dL up to day 4 after birth, this level then dropping over the next week until reaching normal levels.

Breastfed babies are more likely to develop moderate jaundice than formula-fed babies with levels up to 12 mg/dL. Breast milk jaundice is supposed to be an extended form of physiological jaundice.

Newborns having multiple risk factors can aggravate physiological jaundice, with bilirubin levels as high as 17mg/dL.

Breast milk jaundice is found to develop in around 30% of healthy breastfed babies. The condition usually remains around 5 days after birth with a level of bilirubin between 12-20mg/dL and this level begins to fall around 2 weeks after birth. 

However, around 10% of these babies suffer from elevated levels at one-month post-birth and it may last until 12 weeks.

Pathological jaundice appears within 24 hours after birth and the bilirubin level continues to rise more than 5mg/dL per day. 

In a full-term newborn, a bilirubin level may reach higher than 17 mg/dL. A number of physiological disorders (like biliary atresia) cause pathological jaundice.

WHAT CAUSES JAUNDICE IN NEWBORNS


An elevated bilirubin level or hyperbilirubinemia in a baby is the general cause of jaundice in newborns. When red blood cells are broken down in the liver, bilirubin, a yellow pigment is obtained as a waste product and it is removed from the body with feces.

In the normal state, the liver filters the bilirubin from the bloodstream and releases it into the intestinal tract from which it is excreted with feces. The immature or underdeveloped liver of a newborn child is often not capable to remove bilirubin, which leads to an excess of bilirubin. 

The build-up of this excess amount of bilirubin in the body causes jaundice. This is physiological ("normal") jaundice. The symptoms of jaundice usually appear on the second or third day after birth.

Other causes of jaundice in the newborn are-


1.      Sometimes a child swallows blood during birth. This swallowed blood breaks down in the child's intestines and the bilirubin that is produced is absorbed into the bloodstream.

2.       Born premature: Premature babies born before 38 weeks of gestation have even less ability to remove bilirubin the full-term born babies. Premature babies are fed less; as a result, they have less bowel movement and have a lower chance of bilirubin elimination through stool.

Breastfeeding jaundice: This happens when the baby does not gets enough breast milk in the first few days of life. This may be due to the baby is having trouble breastfeeding or if the mother's milk is slow to come in. 

It is better to feed the baby more often. Take the help of a breastfeeding (lactation) consultant.
Breast milk jaundice: This happens in breastfeed babies as breast milk contains a certain substance that prevents the liver from quickly removing bilirubin. It happens after the first week of life and peaks at 2-3 weeks. The condition slowly improves over 3–12 weeks.

Blood incompatibility between mother and baby:  If the baby has a different blood type from the mother, the mother's body makes antibodies that attack the baby's red blood cells. 

This happens when:


ABO incompatibility: The baby's blood type is A or B and the mother's blood type is O or
Rhesus incompatibility: the baby's Rh factor is positive and the mother is Rh-negative. (Rh factor depends on a protein found on red blood cells)

Genetic Factor: If the baby has a genetic defect that makes the red blood cells more fragile and breaks easily. Hereditary spherocytosis and G6PD deficiency are to genetic a condition where the Red blood cells break down more easily and produce more bilirubin.

Polycythemia: A newborn baby may be born with a high number of Red Blood Cell and these cell breaks down rapidly producing more bilirubin.

Cephalohematoma: During delivery, a newborn may develop a large bruise on the head. This baby may have higher levels of bilirubin from the breakdown of more red blood cells. 

Crigler-Najjar syndrome: This is an inherent disorder of bilirubin metabolism affecting infants. This condition is manifested by a high level of unconjugated bilirubin and leads to brain damage in newborns.   

Lucey-Driscoll syndrome: This is a similar metabolic disorder that can cause jaundice in neonatal.
In addition, there are some other conditions that can cause jaundice, including:

§  Hypoxia - Low Oxygen Levels
§  Enzyme deficiency
§  Bacterial or virus infection
§  Internal bleeding
§  Child's blood infection (sepsis)
§  Differences between the mother's blood and the baby's blood
§  Liver failure        

SYMPTOMS OF JAUNDICE IN A NEWBORN


Symptoms of newborn jaundice usually develop two to three days after birth. The most common symptom of infant jaundice is pale skin and yellow sclera (sclera is the white part of the eye). The yellowing of skin usually begins at the head and spreads to the chest, abdomen, arms, and legs.
Other symptoms of jaundice in newborns may include:

•        No gain of weight.
•        Drowsiness.
•        Production of pale stool.
•        Weakness in sucking or feeding milk.
•        High-pitched crying.
•        Irritability.
•        Fever
•        The yellow appearance of body parts like the eye, face, the palm of the hand.
•        Dark yellow urine - while the urine of the newborn should be colorless.
(Read more - Causes of a baby crying and ways to silence her… )

HOW IS NEONATAL JAUNDICE DIAGNOSED?


In order to treat a baby properly, it is very important to find out the exact cause of Newborn jaundice. The doctor diagnoses neonatal jaundice based on the symptoms of the infant. However, the process of diagnosis of jaundice requires the doctor to measure the level of bilirubin in the infant's blood. 

Bilirubin levels help determine the severity and treatment of jaundice. Tests to determine jaundice include:

•                    ON THE BASIS OF A PHYSICAL EXAMINATION - the doctor examines the yellowing of the newborn's skin, eyes, the palm of the hand.

•                    A LABORATORY TEST OF THE BABY'S BLOOD SAMPLE - Serum bilirubin levels can be checked from the bay’s blood sample. Depending on the results of this test, the doctor may suggest other tests.

•                    TRANS CUTANEOUS BILIRUBINOMETER - In newborns, the skin is tested by an instrument, called a transcutaneous bilirubin meter, which measures the reflection of a particular light through the skin. With the help of this instrument, the level of bilirubin is measured without blood tests.

•                    COOMBS TEST - Through this test, antibodies that attack red blood cells are detected.

•                    If newborn jaundice persists for more than 2 weeks, the doctor may suggest a full blood test or urine test to detect underlying disorders of the jaundice of the baby.

Treatment is recommended if bilirubin levels reach:     
 
15mg/dL in newborns 25-48 hours old
18 mg/dL in newborns 49-72 hours old
20 mg/dL in newborns older than 72 hours

TREATMENT OF NEWBORN JAUNDICE


Treatment of newborn jaundice depends on 3 factors:-
1)   the cause of jaundice,
2)   the bilirubin levels, and
3)   the baby's age.

Newborn jaundice usually resolves on its own within two or three weeks in normal children. Moderate or severe jaundice may require keeping the baby in a hospital for a long time.

The following treatments can be recommended to reduce the level of bilirubin in the blood of a newborn:

1.     Phototherapy Or Light Therapy To Treat Newborn Jaundice:


Under this therapy, the child is kept with exposed skin in the light of a special type of blue-green spectrum. 

This light can penetrate a baby’s skin and changes the size and structure of bilirubin molecules, and convert it into lumirubin, which is easily excreted out of the baby’s body through urine and feces. This light is not an ultraviolet light and a protective goggle is a place in the baby’s eyes to protect from the ultraviolet light emitted in any way.

2.     Fluid:


It is very essential that the newborn get enough fluids during phototherapy. A loss of fluids or dehydration will cause bilirubin levels to rise. So, enough breasts or bottle-feeding to be maintained. A baby who is severely dehydrated or unable to suck mar requires to give fluid intravenously.    
              

3.     Intravenous Immunoglobulin For Treatment Of Newborn Jaundice:


Jaundice caused due to the incompatibilities in blood between mother and child is given this immunoglobulin intravenously.  Because of this condition, the baby receives antibodies from their mother. 

This antibody can cause the breakdown of red blood cells in the child. Intravenous transfusion of immunoglobulin, a blood protein that blocks the antibodies that attack red blood cells and contribute to lowering jaundice in infants and can also reduce the need for a blood transfusion as well.

4.     Exchange Blood Transfusion For Treatment Of Newborn Jaundice:


This treatment is the last resort done in severe jaundice when very high bilirubin levels do not come down with phototherapy or other treatments.  The baby's blood is exchanged with donated blood which is free from maternal antibodies and lower bilirubin to quickly lower bilirubin levels. This procedure is done under an intensive care facility.

COMPLICATIONS OF NEONATAL JAUNDICE

Neonatal jaundice in most cases is harmless and disappears naturally without treatment after a few weeks. In a few cases, infant jaundice if is not treated in time, it can cause serious complications or problems.

       I.            Acute Bilirubin Encephalopathy - The chemical responsible for jaundice disease is bilirubin, which is toxic to brain cells.  There is a risk of bilirubin passing into the brain; in a baby have severe jaundice and this condition called acute bilirubin encephalopathy.

Symptoms of acute bilirubin encephalopathy in a child include:

·        Fever,
·        Sluggishness,
·        High-pitched crying and
·        Twisting body or neck.

Immediate treatment in this situation may avert any significant and lasting damage.

    II.            Kernicterus- Kernicterus is a potentially fatal syndrome in which several symptoms appear simultaneously in the disease. It causes permanent brain damage from acute bilirubin encephalopathy. Kernicterus may result in:

·        Athetoid cerebral palsy- Uncontrolled and involuntary and movements,
·        Permanent upward gaze,
·        Loss of hearing,
·        Inappropriate development of tooth enamel.     
 
Other serious, but rare complications include deafness and cerebral palsy (paralysis).

RISK FACTORS OF NEWBORN JAUNDICE

Common risk factors for infant jaundice in the newborn are:

1.     Premature Birth – A premature baby born before 38 weeks of gestation may is unable to process bilirubin at the same rate as full-term babies do. Premature infants have severely underdeveloped liver and low bowel circulation, which means slower filtering and less excretion of bilirubin with feces.

2.     Breastfeeding- If babies do not get enough nutrients or energy from breastfeeding or remain dehydrated, those children are more likely to have jaundice.

3.     Injury During Birth - This can cause the condition to rapidly break down red blood cells, resulting in high levels of bilirubin.

(Read more - Diet For Breastfeeding Mothers To Increase Milk: BEST FOOD FOR NEW MOMS)

HOW TO PREVENT JAUNDICE IN NEWBORNS


The following measures should be adopted for the prevention of Newborn jaundice in the infant.
v The best way to prevent jaundice in the newborn is an adequate and proper diet. Breastfeeding should be done 8 to 12 times daily for a few days after birth.

v If a mother has any questions or concerns related to breastfeeding her baby, talk to a breastfeeding consultant.

vFormula-fed babies should normally have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours interval for the first week.

v During pregnancy, a mother may undergo her own blood test.

v Keep the child under extreme supervision for the first five days after birth and a doctor should be consulted if symptoms related to infant jaundice are found.

HOME REMEDIES FOR JAUNDICE IN NEWBORN BABY

Some home remedies can be adopted for the treatment of Newborn jaundice in a newborn baby, which are as follows:-

1)   Sunlight For At-Home Treatment For Baby Jaundice –


Sunlight helps break down bilirubin in case of jaundice so that the baby's liver can make it out more easily. Keep your child in a lighted window twice a day for 10 minutes, this method helps to cure mild jaundice. Do not place the baby in direct sunlight.

2)   Feed the Newborn More Often -


The more often you feed your baby, the more will be the bowels and this will speed up the process of eliminating excess bilirubin from the bloodstream with the feces. 

Babies suffering from jaundice are often feeling sleepy, so the mother may need to wake the baby to nurse her. Newborns with jaundice must be fed every 2 to 3-hour intervals or more often if they are hungry.

3)   Supplements With The Formula –


Breastfed babies may require supplements as they may not get enough breast milk in the early days. Add formula supplements along with breast milk after consultation with your lactation consultant. If your pediatrician permits use infant formula to supplement to feed your baby until jaundice clears up.

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