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NEWBORN JAUNDICE
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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?
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
suffers 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 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 BABY?
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 begin 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
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) that 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 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 feed 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 not getting 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 help of 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 develops 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 eye, face, the palm
of the hand.
•
Dark yellow urine - while the urine of the newborn
should be colorless.
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 bilirubinometer, 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 breakdown
red blood cells, resulting in high levels of bilirubin.
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 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.
v
Formula-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. Newborn 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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