Jaundice In Newborns: Causes, Symptoms And Treatment

Jaundice In Newborn Baby

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Jaundice turns your baby yellow. His eyes, skin, and urine turn yellow, leaving you disturbed. Jaundice happens due to the surplus of the body compound called bilirubin. The condition has several biochemical origins and occurs in babies even a few days old. Treatment is essential and is quite readily available. In this MomJunction post, we will tell you why jaundice is caused in babies, what could its possible complications be, and how your baby can come out of it.

What Is Jaundice In Babies?

Jaundice is the condition where the body produces more bilirubin than the liver can process. Bilirubin is a byproduct of natural red blood cell (RBCs) destruction process. The liver processes bilirubin for the formation of bile that aids in digestion. The excess bilirubin flows into the bloodstream and enters body cells. Since bilirubin has a natural yellow color, it turns the cells and thereby the skin and eyes yellow. Jaundice in infants is known as neonatal hyperbilirubinemia.

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What Causes Jaundice In Babies?

There are different types of jaundice in babies each having its own cause.

  1. Physiological jaundice, also called physiologic jaundice, appears two to four days after birth and disappears in a couple of weeks. It is considered normal in newborns since the liver is young and is developing its ability to process bilirubin (1). About 50% newborns suffer from this condition (2).
  1. Jaundice of prematurity is similar to physiological jaundice, but occurs in premature babies (3). The liver in preterm infants is lesser developed than full term ones. It leaves premature babies susceptible to jaundice. About 80% preterm babies suffer from this condition (4).
  1. Breastfeeding jaundice, also called malnutrition jaundice, occurs when the baby is not fed enough breastmilk, maybe because the mother is unable to produce breastmilk or she has not been knowing if the baby is full. Breastfeeding jaundice is not due to a problem in the breastmilk, but due to its deficiency that affects the liver’s abilities. Along with yellowness, the baby will become underweight. Breastfeeding jaundice affects 5 to 10% of newborns and resolves when the baby receives adequate breastmilk.
  1. Breastmilk jaundice is caused by biochemical abnormalities in the mother’s milk that prevent the baby’s liver from breaking down the bilirubin (5). The condition appears four to seven weeks after birth and affects 10% of newborns. It is not harmful and resolves on its own in 12 weeks.
  1. Jaundice of hemolysis, also known as Rh and ABO incompatibility jaundice, occurs when the mother’s and fetus’ blood group are not the same. In such cases, the mother’s body releases antibodies that destroy the fetus’ RBCs. This surge the bilirubin in the infant’s body, and the baby is born with jaundice. First symptoms of jaundice are noticed 24 hours after birth and this jaundice in neonates is serious yet, rare.
  1. Pathological jaundice leads to prolonged jaundice in the newborn as it could be a liver disease. There are numerous reasons for a liver disease, but the most common one is hepatitis. Hepatitis is caused by any hepatitis virus – A, B, C, D, or E – contracted by the infant (6). Biliary atresia, a rare condition, could also cause jaundice. The bile duct gets blocked leading to bile stagnation, which scars liver tissue eventually failing the liver (7).

The different kinds of jaundice share the same symptoms.

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What Are The Symptoms Of Jaundice In Babies?

The baby will show the following symptoms when he has jaundice:

  • Yellow discoloration of skin is the hallmark symptom of jaundice. The color first appears on the face, followed by chest, abdomen, arms, and legs in consecutive order. The American Academy of Paediatrics (AAP) recommends checking the yellowness of skin in sunlight or bright fluorescent lights (8).
  • The whites of the eyes, medically known as sclera, will appear yellow.
  • When you gently press the infant’s skin on the forehead or the nose, it turns yellow. This indicates that the baby has mild jaundice (9).

The above three symptoms are the primary indicators of jaundice. However, severe jaundice has the following symptoms.

Symptoms of severe jaundice:

These indicators point towards extremely high levels of bilirubin in the baby’s body:

  • Loss of appetite
  • Drowsiness and lethargy
  • Baby cries in a high pitch
  • Fever with rectal temperature above 100°F (37.8°C)
  • Diarrhea
  • Vomiting

A baby with these symptoms should be rushed to the doctor immediately for a medical diagnosis.

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How Is Jaundice Diagnosed?

A doctor will use the following methods to diagnose jaundice in the baby:

  • The doctor will assess the baby’s skin and eyes for yellow discoloration and may use specialized equipment to measure the intensity of the light reflected by the skin (10). This physical examination helps determine mild cases of jaundice or when the yellowness is hard to spot due to the baby’s dark skin.
  • The baby’s blood is tested to measure the bilirubin levels and healthy RBC levels.
  • Urine and stool tests help guage liver infections and disorders that may lead to jaundice.

The baby should be checked by the doctor once every day for the first three days, and then on the fifth day. The first five days display highest bilirubin levels due to neonatal jaundice. Below is a serum bilirubin level chart for the first five days and the corresponding risk of jaundice.

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Baby Jaundice Level Chart

Age in daysNormal bilirubinLow riskLow intermediate riskHigh Intermediate riskHigh risk
OneBelow 5mg/dl5mg/dl5 – 6mg/dl6 – 7.7mg/dlAbove 7.7mg/dl
TwoBelow 8.5mg/dl8.5mg/dl8.5 – 11mg/dl11 – 13mg/dlAbove 13mg/dl
ThreeBelow 11mg/dl11mg/dl11 – 13.3mg/dl13.3 – 16mg/dlAbove 16mg/dl
FourBelow 12.3mg /dl12.3mg /dl12.3 – 15mg/dl15 – 17.3mg/dlAbove 17.3mg/dl
FiveBelow 13.2mg/dl13.2mg/dl13.2 – 15.7mg/dl15.7 – 17.5mg/dlAbove 17.5mg/dl

Source: American Academy of Pediatrics (11)

Many hospitals check the bilirubin levels of the baby as part of the regular delivery procedure. In cases of preterm infants a blood test is usually done. Detection of the condition helps initiate the treatment on time.

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How Is Jaundice In Babies Treated?

One of these three most common treatment methods is used based on the severity of jaundice:

  1. Phototherapy is the first choice of treatment in all types of jaundice. The baby is placed in a special hospital crib, wearing only a diaper and an eye-band, illuminated by overhead bulbs emitting light in blue-green spectrum. The light affects excess bilirubin by changing its molecular structure. The modified bilirubin is easily processable by the liver and is expelled through the infant’s stool and urine. The treatment works well when maximum skin surface receives the light. Biliblankets, which are specialized electrical blankets that emit blue-green light, could be placed under the infant to maximize the effect of the treatment (12). They are portable and can be placed in the baby’s crib at home. The duration and frequency of the phototherapy treatment depends on the severity of jaundice (13).
  1. Immunoglobulin injections work specifically against jaundice of hemolysis. An immunoglobulin injection helps bring down the antibody levels in the baby’s body thus halting the excess loss of RBCs. It invariably leads to lesser bilirubin formation, treating jaundice.
  1. In case of pathological jaundice, the treatment would be to cure the infection. For instance, if jaundice is caused due to hepatitis, then the doctor will recommend supportive care for the baby. The body’s immune system has to work at eliminating the virus itself. Relevant supportive care such as rest, nourishment, and symptom alleviation can help the baby recover better.
  1. Exchange blood transfusion is done when bilirubin rich blood is removed from the baby’s body and replaced by an equivalent portion of healthy blood. The transfusion is repeated until the entire blood is free of excess bilirubin. This treatment is quite rare and only employed when the baby does not respond to other treatments.

Treatment of jaundice is vital since when left untreated, the disease can lead to severe complications that are life-threatening.

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Complications Of Jaundice In Infants

An untreated severe jaundice can lead to the following conditions:

  1. Acute bilirubin encephalopathy: When bilirubin levels get too high, it affects the brain by destroying the neurons, and causes neurological disorders. This condition is known as acute bilirubin encephalopathy.
  1. Kernicterus: In this advanced stage of acute bilirubin encephalopathy, bilirubin causes permanent damage to the infant’s brain. It causes hearing loss, involuntary muscle contractions, and damage to eye muscles.

The above dangers of jaundice occur only when the baby is left totally untreated, which is quite unlikely given the the glaring yellow skin and eyes. Parents can do a lot for the baby even when the treatment is going on.

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How To Manage Infantile Jaundice?

A baby with jaundice can be made to feel comfortable and better by following the below steps.

  • If the baby has breastfeeding jaundice, then you must feed the baby as frequently as possible to help bring down the bilirubin levels. In cases of breastmilk jaundice, the doctor prescribes a specialized formula. However, formula can be alternated with breastmilk when the baby’s body begins tolerating mother’s milk. The AAP recommends breastfeeding even when the baby suffers from any type of jaundice.
  • Parents can have their version of phototherapy right at home. Sunlight does a similar job as light treatment – by excreting excess bilirubin. However, it is not a full-fledged treatment. Parents can place the baby under soft sunrays early in the morning or capture the rays through a glass pane to avoid any sunburns. Just like phototherapy, the infant must be dressed only in diaper and have an eye-band. Ensure the temperature at home is neither too cold nor hot. Sunlight exposure for jaundiced babies is widely recommended by experts.

Management of jaundice at home along with a few treatment methods helps the little one recover faster. However, it is always best to avoid a disease by working on its prevention.

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How To Prevent Jaundice In Babies?

It is hard to prevent most kinds of jaundice since they occur spontaneously in newborns without any external stimulus. Physiological jaundice and jaundice in premature babies are normal and are not under parent’s or doctor’s control. Jaundice of hemolysis, breastmilk jaundice, and breastfeeding jaundice canot be avoided as they are diagnosed at birth. Only pathological jaundice is preventable. You can keep it at bay by taking the below measures:

  1. Have the baby vaccinated: Most infants get vaccinated for hepatitis B soon after birth, and this vaccine even protects the infant from hepatitis D. The hepatitis A vaccine is can also be administered to the little one once he is two years old.
  1. Give the infant hygienically-prepared food: Babies should eat well-cooked and hygienically prepared foods. This reduces the chances of the infant contracting a hepatitis virus, liver infection, or any other infections through pathogens that might be present in contaminated foods. Give the baby only filtered and purified water. Buy only ripe fruits and wash them thoroughly before feeding.
  1. Maintain hygiene around baby: Always wash your hands after changing the baby’s diapers. The baby’s hands must be washed after he is done playing outdoors. Even when you touch his things, ensure that your hands are washed. Keep the house and surroundings of the baby clean and hygienic.

Jaundice is a complicated ailment, but fortunately it can be detected easily. Most infants recover quickly and do not need an elaborate treatment. So, watch out for the signs and take the baby to the doctor.

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  • momjunction

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