About neonatal jaundice

What is neonatal jaundice?

Infant jaundice is yellow discoloration of a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells.

Infant jaundice is a common condition, particularly in babies born before 38 weeks' gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby's liver isn't mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice.

Most infants born between 35 weeks' gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

What are the symptoms for neonatal jaundice?

To check for infant jaundice, press gently on your baby's forehead or nose. If the skin looks yellow where you pressed, it's likely your baby has mild jaundice. If your baby doesn't have jaundice, the skin color should simply look slightly lighter than its normal color for a moment.

Examine your baby in good lighting conditions, preferably in natural daylight.

What are the causes for neonatal jaundice?

Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. 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. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn's immature liver often can't remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.

Other causes

An underlying disorder may cause infant jaundice. In these cases, jaundice often appears much earlier or much later than does the more common form of infant jaundice. Diseases or conditions that can cause jaundice include:

  • Internal bleeding (hemorrhage)
  • An infection in your baby's blood (sepsis)
  • Other viral or bacterial infections
  • An incompatibility between the mother's blood and the baby's blood
  • 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

What are the treatments for neonatal jaundice?

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 your baby's blood may include:

  • Enhanced nutrition. To prevent weight loss, your doctor may recommend more-frequent feeding or supplementation to ensure that your baby receives adequate nutrition.
  • Light therapy (phototherapy). Your baby may be 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, your 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 may be related to blood type differences between mother and baby. This condition results in the baby carrying antibodies from the mother that contribute to the rapid breakdown of the baby's red blood cells. Intravenous transfusion of an immunoglobulin — a blood protein that can reduce levels of antibodies — may decrease jaundice and lessen the need for an exchange transfusion, although results are not conclusive.
  • Exchange transfusion. Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood and replacing it with donor blood, thereby diluting the bilirubin and maternal antibodies — a procedure that's performed in a newborn intensive care unit.

What are the risk factors for neonatal jaundice?

Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:

  • Premature birth. A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.
  • Significant bruising during birth. Newborns who become bruised during delivery gets bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.
  • Blood type. If the mother's blood type is different from her baby's, the baby may have received antibodies through the placenta that cause abnormally rapid breakdown of red blood cells.
  • Breast-feeding. Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breast-feeding, experts still recommend it. It's important to make sure your baby gets enough to eat and is adequately hydrated.
  • Race. Studies show that babies of East Asian ancestry have an increased risk of developing jaundice.

Is there a cure/medications for neonatal jaundice?

Neonatal jaundice, also named infant jaundice, in mild cases, often disappears on its own within two or three weeks. In severe conditions, your child may need the following treatments.

  • Good nutrition: there are recommendations for frequent feedings and other supplements for nutrition
  • Phototherapy: A spectrum of blue and green light bulbs is placed for a baby; this light changes the shape and structure of bilirubin and can be extracted by stool or urine.
  • Exchange Transfusion: When other treatment does not work, the baby's blood is changed by a small amount with the help of a donor. Doing so dilutes the bilirubin and maternal antibodies.
  • Intravenous Immunoglobulin (IVIG): if there is jaundice related to the difference in blood type between mother and baby, then the antibodies that the baby carries from the mother help for the breakdown of red blood cells, then IVIG of immunoglobulin — a blood protein that can reduce this condition.
  • Furthermore, the guidance to parents for identification this situation for newborns helps better for early treatments.
  • Home remedies: In mild conditions, your doctor may recommend changes in feeding habits that can lower bilirubin levels.
  • Feeding frequently will give more milk to your baby, causing more bowel movements, and increasing the amount of bilirubin eliminated in your baby's stool. Breast-fed infants should have eight to 12 feedings a day for the first several days of life.


Symptoms
Yellow coloration of the skin and sclera,Look for yellow skin in your infants, if pressed
Conditions
A mild, transient, and self-limiting condition (physiological Jaundice),Pathological Jaundice in severe cases
Drugs
Light therapy (phototherapy),Light-emitting pad or mattress,Intravenous immunoglobulin (IVIg),Exchange transfusion (withdrawing small amounts of blood and replacing it with donor blood)

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