Newborn Jaundice – Causes, Symptoms and Treatment

The skin and eyes of a newborn may seem yellow due to newborn jaundice, which is a common and usually innocuous disease. It usually happens in babies born before 38 weeks of pregnancy and some breastfed babies. Generally, infant jaundice occurs because the liver of a baby is not mature enough to get rid of bilirubin in the bloodstream. 

When too much bilirubin — a substance released by red blood cells during their regular breakdown process — piles up in the blood, it causes jaundice. It may go away on its own, or the doctor may recommend light therapy or other treatments to help get rid of it.

When a baby’s liver isn’t developed enough to get rid of bilirubin in the bloodstream, it causes jaundice. Jaundice because of these normal newborn conditions is known as physiologic jaundice. Typically, it appears on the second or third day of life.

Infant jaundice can also be caused by an underlying condition in certain neonates, such as:

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• Sickle cell anemia
• Liver disease
• Sepsis – a blood infection
• Bleeding under the scalp (cephalohematoma) – due to a difficult delivery
• Abnormality of the child’s red blood cells
• Greater numbers of red blood cells – more common in twins and smaller babies 
• Mother and child have different blood types and the antibodies of the mother assault the child’s red blood cells, leading to rhesus or ABO incompatibility.
• Enzyme deficiency 
• Blocked bile duct or bowel
• Hypothyroidism (underactive thyroid gland)
• Viral or bacterial infections
• Hepatitis (inflammation of the liver)
• Hypoxia (low oxygen levels_
• Infections such as rubella and syphilis 

Causes of newborn jaundice

An excess of bilirubin, the yellow pigment causes infant jaundice. Bilirubin is created as a waste product when the red blood cells are broken down. Usually, it is broken down in the liver and excreted through the bowels.

Bilirubin is a natural component generated during the breakdown of “used” red blood cells.

Because of the higher creation and faster breakdown of red blood cells in the first few days of life, newborns produce more bilirubin than adults. Bilirubin is normally filtered from the bloodstream and released into the intestine by the liver. The immature liver of a baby is typically unable to eliminate bilirubin quickly enough, resulting in an excess of bilirubin. Physiologic jaundice is a type of jaundice that arises on the second or third day of life.

Breast-feeding can also cause infant jaundice. It displays itself in two ways in breast-fed newborns:

• Breastfeeding jaundice develops in the first week of life if the infant does not feed adequately or if the mother’s milk takes a long time to arrive.
• Breast milk jaundice is caused by chemicals in the breast milk interfering with the bilirubin breakdown process. It starts after 7 days of life and lasts for 2-3 weeks.

Symptoms of newborn jaundice

A yellow tone to the baby’s skin and yellow in the whites of their eyes are clear signs of jaundice. It usually begins on the face. The yellow tint spreads to the chest and stomach as bilirubin levels in the blood rise, then to the legs and arms. Consult the doctor straight away if the baby:

• Isn’t feeding properly
• Isn’t wetting the diaper
• Is difficult to wake up 
• Is wailing incessantly or in a high-pitched cry.
• Has arched spine and he or she is limp or stiff.
• Has unusual movements of eyes

Infant jaundice can also cause the following symptoms:

• Drowsiness
• Stool of mild greenish-yellow tint for breastfed newborns and a greenish-mustard color for bottle-fed babies.
• Dark pee – a newborn’s urine should be colorless 

The following are the symptoms of severe newborn jaundice:

• Drowsiness
• Yellow abdomen or limbs
• Irritability
• Failure to gain weight
• Poor feeding

Risk factors of newborn jaundice

The following are main risk factors for jaundice:

Premature delivery– A newborn born before 38 weeks of pregnancy may not be able to process bilirubin at the same rate as a full-term infant. Premature babies may also have fewer bowel movements and feed less, resulting in less bilirubin being excreted in the stool.

Bruising during delivery– Newborns that are injured during delivery may have greater bilirubin levels due to the breakdown of more red blood cells.

Blood type– If the mother’s blood type differs from that of her infant, the baby may have been exposed to antibodies through the placenta, causing abnormally rapid red blood cell destruction.

Race– According to studies, babies with East Asian ancestry have a higher risk of having jaundice.

Complications of newborn jaundice

If untreated, high levels of bilirubin that produce acute jaundice can lead to catastrophic problems.

Acute bilirubin encephalopathy (ABE) 

Bilirubin is toxic  to brain cells. A disorder known as acute bilirubin encephalopathy occurs when a neonate has severe jaundice and bilirubin passes into the brain. Prompt treatment may help to prevent long-term damage.

In an infant with jaundice, signs of acute bilirubin encephalopathy include:

• Listlessness
• Having trouble waking up
• Crying with a high volume
• Sucking or feeding problems
• The neck and body arch backwards.
• Fever

Kernicterus

Kernicterus is a syndrome that develops when acute bilirubin encephalopathy results in permanent brain damage. Kernicterus can lead to:

• Uncontrollable and involuntary movements (athetoid cerebral palsy)
• A constant upward look
• Hearing loss is a common problem.
• Improper tooth enamel development 

Diagnosis of newborn jaundice

A doctor can usually identify if the newborn has jaundice just by looking at him. However, they’ll want to know how much bilirubin is in the baby’s blood in order to determine a treatment strategy. They could:

• Take the baby’s blood and submit it to a lab to be tested for bilirubin levels and types.
• Testing the skin using a device called transcutaneous bilirubinometer. It measures the reflection of a special light shone through your skin

Other tests may be performed if the doctor feels a condition is causing the baby’s jaundice, such as:

• A sample of urine was taken to check for infection.
• A complete blood count is used to determine the quantity of red blood cells in the body.
• A reticulocyte count is used to determine whether the quantity of freshly generated red blood cells is within normal limits.
• A blood type test is performed to determine whether the mother’s blood is incompatible with the baby’s blood.
• A Coombs test to detect if the baby’s red blood cells are being destroyed by the immune system.
• A liver function test normal range

Treatment of newborn jaundice

Jaundice usually clears up on its own in 1 to 2 weeks. The doctor will choose whether the child should wait or begin treatment, such as:

Extra feedings required: Increasing the baby’s intake of breast milk or formula will encourage him or her to defecate more frequently, which will aid in the removal of bilirubin from the body. If the infant is having problems nursing, the doctor may advise the mother to bottle feed breast milk or supplement with formula.

Phototherapy (light therapy): The baby is placed under a special light that is shielded from UV rays by a plastic shield. The light changes the structure of bilirubin molecules, allowing them to pass out of the body.

Exchange blood transfusion: Blood is removed from the newborn and replaced (exchanged) with donor blood on a regular basis. As the baby would need to be in an intensive care unit (ICU) for newborns, this treatment will only be considered if phototherapy fails.

Intravenous immunoglobulin (IVIg): In cases of rhesus or ABO incompatibility, the newborn may get an intravenous immunoglobulin (IVIg) transfusion; this is a protein in the blood that decreases the levels of antibodies from the mother that attack the infant’s red blood cells.

Prevention from newborn jaundice

There’s no way to stop newborns from getting jaundice. Expecting mothers can have the blood type tested while pregnant.

If necessary, the baby’s blood type will be tested after birth to rule out blood type incompatibility, which can cause neonatal jaundice. If the baby does have jaundice, there are some things that can be done to prevent it from getting worse:

• Ascertain that the baby is receiving adequate nourishment from breast milk. Feeding the infant 8 to 12 times a day for the first few days keeps them hydrated, allowing bilirubin to move out of the system more quickly.
• During the first five days after delivery, keep an eye out for signs of jaundice, such as yellowing of the skin and eyes.
• If the mother discovers that the baby is showing signs of jaundice, contact the doctor immediately.