Jaundice in newborns is a common phenomenon and often goes away without complications, as half of the children in term newborns and most of the premature infants have jaundice in the first week of their life, and the peak of the disease in term newborns reaches between the third and fifth day of their life.
While it occurs at a later period in premature infants, the younger the preterm age is at the gestational age, the longer the jaundice continues, and jaundice in newborns is normal in the absence of another problem that causes its formation.
The reasons for the activation of body mechanisms that increase the values of indirect bilirubin during childbirth are not clear, the current accepted hypothesis is that the body needs bilirubin as an antioxidant because the level of other antioxidants is low during this period.
In some newborns, high levels of bilirubin are due to a pathological injury, and the newborn''s jaundice is abnormal.
Symptoms of jaundice in newborns
Yellowing of the skin and whites of the eyes is usually the main sign of jaundice in infants between the second and fourth day after birth. The following signs or symptoms may indicate severe jaundice:
The skin of the child becomes more yellow.
The skin on the baby''s abdomen, arms, or legs appears yellow.
The whites of the baby''s eyes appear yellow.
The child appears listless, ill, or has difficulty waking up.
The child is not gaining weight or feeding poorly.
The child cries loudly.
Your child has any other signs or symptoms that worry you.
Causes and risk factors for jaundice in newborns
The following is an explanation of the causes and risk factors for jaundice in newborns
1. Causes of jaundice in newborns
Excess bilirubin is the main cause of jaundice. The bilirubin responsible for the yellow color of jaundice is a normal part of the pigment produced by the breakdown of red blood cells.
Newborns produce more bilirubin than adults because of increased red blood cell production and faster breakdown in the first few days of life. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestines.
Often the immature liver of newborns is not able to remove bilirubin quickly enough, causing an increase in bilirubin.
Other major reasons include the following
Internal bleeding.
An infection in the child''s blood.
Other viral or bacterial infections.
The mother''s blood is incompatible with the baby''s blood.
Liver dysfunction.
Obstruction of the child''s bile ducts or the appearance of scars in them.
2. Risk factors for jaundice in newborns
The main risk factors include the following
The main risk factors for jaundice, especially severe jaundice, which can cause complications, include the following:
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 may also feed less and have fewer bowel movements, resulting in less bilirubin being eliminated through the stool.
Severe bruising during childbirth
Newborns who bruise during delivery have bruising from birth and may have higher levels of bilirubin from breaking down more red blood cells.
blood type
If a mother''s blood type is different from her baby''s, the baby may have received antibodies across the placenta that cause abnormally rapid breakdown of red blood cells.
Breastfeeding
Breastfed babies, especially those who have difficulty feeding or getting enough nutrition from breastfeeding, are more likely to develop jaundice.
Dehydration or a low calorie intake may contribute to jaundice, however due to the benefits of breastfeeding it is still recommended by experts and it is important to make sure your baby is getting enough food and is adequately hydrated.
Sweat
Studies show that children of East Asian descent have an increased risk of developing jaundice.
Complications of jaundice in the newborn
High levels of bilirubin that cause severe jaundice can lead to serious complications if not treated. The most common complications include:
1. Acute bilirubin encephalopathy
Bilirubin is toxic to brain cells. If a child has severe jaundice, there is a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy. Prompt treatment may prevent significant permanent damage.
Signs of acute bilirubin encephalopathy in a child with jaundice include
idleness.
difficulty waking up
High-pitched crying.
poor lactation
Back curvature of the neck and body.
Fever.
2. kernicterus
It is a syndrome that occurs if acute bilirubin encephalopathy causes permanent damage to the brain. Jaundice may result in:
Involuntary and uncontrolled movements.
Permanent look up.
hearing loss.
Improper development of tooth enamel.
Diagnosis of jaundice in the newborn
Your doctor is likely to diagnose jaundice in infants based on the baby''s appearance. However, it is still necessary to measure the level of bilirubin in the baby''s blood. The level of bilirubin will determine the severity of the jaundice and therefore the course of treatment. Tests to detect jaundice and measure bilirubin include the following:
Physical examination.
Blood test.
The skin test is done with a device called a transcutaneous bilirubinometer, which measures the reflection of a special light shining through the skin.
Your doctor may order additional blood or urine tests if there is evidence that your baby''s jaundice is caused by an underlying disorder.
Treatment of jaundice in newborns
Mild jaundice in infants often goes away 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 reduce the level of bilirubin in a child''s blood may include the following
1. Proper nutrition
To prevent weight loss, your doctor may recommend proper nutrition or supplementation to ensure your child gets adequate nutrition.
2. Phototherapy
The baby can be placed under a special lamp that emits light in the blue-green spectrum as the light changes the shape and structure of bilirubin molecules in such a way that it can be excreted in urine and feces.
During the treatment your child will only wear diapers and eye pads as the light therapy can be supplemented with a light-emitting pad or mattress.
3. Intravenous immunoglobulin
Jaundice may be related to blood type differences between the mother and the baby as 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 immunoglobulin, a protein in the blood that can reduce antibody levels, may reduce jaundice and reduce the need for a blood transfusion, although results are not conclusive.
4. Exchange transfusion
Rarely, when severe jaundice does not respond to other treatments, the baby may need exchange transfusions. This involves drawing small amounts of blood frequently and replacing it with donor blood, thus diluting the mother''s bilirubin and antibodies, a procedure that is done in the neonatal intensive care unit.
Prevention of jaundice in newborns
The best prevention for infant jaundice is adequate nutrition. Breastfed babies should have 8-12 feedings per day for the first several days of life.
Usually, formula-fed babies should drink about 30 to 60 milliliters of formula every two to three hours for the first week.
