Neonatal Jaundice: Variations, Causes, and Treatment Methods

Jaundice is the yellowing of the skin and sclera due to a high levels of a pigment called bilirubin within the blood. Bilirubin is produced from the breakdown of hemoglobin. If this is noticed in newborns less than a month old, it is called neonatal jaundice.

The combination of an immature liver (one of the main sites of bilirubin metabolism), a high rate of bilirubin production due to a high rate of red blood cell breakdown, and a high red blood cell concentration make jaundice a common neonatal disease.

How Do I Know If it Is Mild or Severe Jaundice?

One of the confirmed ways of checking the severity of jaundice is under natural light. If only the face is yellow, the jaundice is mild. If the trunk is also yellow, the jaundice is moderate. Also check the limbs, palms, and feet, if they are yellow, then the jaundice is severe.

What Are the Types of Neonatal Jaundice?

Neonatal jaundice is common, but there are different types. They include:

• Physiological jaundice
• Pathological jaundice
• Breastfeeding jaundice
• Breast milk jaundice
• Hemolytic jaundice
• Non-hemolytic jaundice

Physiological Jaundice

Physiological jaundice refers to a common type of jaundice which affects a large number of infants due to certain reasons unique to neonates. It appears as a yellowing of the skin and sclera and disappears within two weeks. This type of jaundice is usually harmless. It might be the liver trying to adjust and work effectively after taking over from the placenta.

What Causes Physiological Jaundice?

During pregnancy, the placenta works as the liver by removing bilirubin from the body. But the placenta leaves after birth and the liver starts its work. It might take some time to adjust fully, thereby making the metabolism of bilirubin slow for some time. This causes physiological jaundice which disappears within two weeks.

How Can Physiological Jaundice Be Treated?

The following treatment should be administered;

• Feed the baby with plain water every morning and evening and also between meals if formula milk is given.

• The baby should be given grape syrup or glucose added to water.

• Bask the baby under the early morning sun. Protect the baby’s eyes while doing this.

• If there is no improvement, do not give breast milk until jaundice disappears.

Pathological Jaundice

If jaundice is detected in a baby within 24 hours after childbirth, it is pathological jaundice. This jaundice is extremely severe as it worsens rapidly. It mostly occurs when the total serum bilirubin level rise by more than 5mg per dL per day which can happen for different reasons. This jaundice lasts longer than other types if not treated properly or late. Pathological jaundice has different causes and different forms.

How Can Pathological Jaundice Be Treated?

Pathological jaundice can be treated in the following ways:

• If the jaundice is severe, the doctor can prescribe drugs.

• The baby can be treated under blue light under a doctor’s guidance.

• The yellow areas should be exposed to direct sunlight while the eyes are shielded.

• If the cause of the pathological jaundice is biliary atresia, surgery should be done within two months of life to prevent other conditions like liver cirrhosis.

Breastfeeding Jaundice

This type of jaundice occurs in the first week of life during breastfeeding. It is be prevented by giving the baby enough breast milk.

What Causes Breastfeeding Jaundice?

This generally occurs when the baby is given a lower amount of breast milk than the optimal amount. The passage of meconium, which is highly rich in bilirubin, is delayed and the bilirubin is transferred into the baby’s circulation; thereby causing jaundice.

Breast Milk Jaundice

Breast milk jaundice occurs in the second week or much later and it lasts for a couple of weeks. It can only happen when the child is still taking breast milk.

What Causes Breast Milk Jaundice?

Breast milk jaundice is caused by the composition of breast milk. Some of its components seem to affect the breakdown of bilirubin.

What Is the Solution for Breast Milk Jaundice?

Breast milk jaundice can be treated by temporary supplementation with donor human milk or formula milk. However, decisions about supplementation of a jaundiced newborn depends on a lot of variables and are to be taken under the guidance of a doctor.

Hemolytic Jaundice

This kind of jaundice can be congenital (inherited) or acquired it is majorly caused by defects done to the red blood cell either by itself (congenital), or by external factors (acquired). These defects damage the red blood cells and lead to the release of a large amount of hemoglobin of which makes the content of non-lipid bilirubin in the plasma higher than that of the liver which causes jaundice

What Causes Hemolytic Jaundice?

Situations and diseases that cause hemolysis also lead to hemolytic jaundice. They include;

• Transfusion between incompatible blood types

• Autoimmune hemolytic anemia

• Hereditary spherocytosis

• Thalassemia

How Can Hemolytic Jaundice be Treated?

To treat the yellowing of skin and eyes, use these methods:

• Blue light irradiation

• Infusion of albumin

• Oral Phenobarbital

Immunoglobulin and other hormones are used in treating the hemolytic part of this jaundice. Transfusion therapy might be needed for severe issues.

Non-hemolytic Jaundice

This type of jaundice is not hemolysis-related. The major form of non-hemolytic jaundice is an autosomal dominant genetic disease. Congenital non-hemolytic jaundice is caused by unconjugated bilirubinemia. It has a characteristic symptom of yellow urine and feces. This jaundice is a chronic intermittent one.

Are there specific signs that indicate this type of jaundice?

In this type of jaundice, the symptoms to watch out for include:

• Yellowing of any tissue that contains elastin in the body (sclera, skin, and mucous membranes).

• The urine, sweat, sputum, and tears of the child turn yellow.

• Discomfort or dull pain around the location of the liver.

• Fatigue

• Loss of appetite

• Nausea and vomiting

• Mild swelling of the liver and spleen

What preventive measures are to be used against non-hemolytic jaundice?

Although it is inherited, congenital non-hemolytic jaundice can also be prevented by doing the following:

• During pregnancy, mothers should eat vegetables and fruits that are very rich in vitamin A.

• Pregnant women should always sleep on time.

• Lutein tablets should be taken during pregnancy.

• Early Pre-marital physical examination and prenatal diagnosis like ultrasound monitoring and chromosome examination should be done to prevent or be aware of certain conditions and start treatment immediately if possible.

In what ways can non-hemolytic jaundice be treated?

Immediate treatment is to be administered once this type of jaundice has been confirmed. Most importantly, go to a pediatric hospital for specific judgment, as this type of jaundice is quite complicated. You can choose a mode of treatment between drug intervention and plasma exchange.

What Are the Other Causes of Jaundice?

If there is any condition that can lead to an increase in the number of red blood cells, neonatal jaundice is bound to occur. Conditions like;

• Sickle cell anemia

• Blood type or Rh incompatibility between mother and baby

• Injuries underneath the scalp that leads to severe bleeding mostly caused by difficult childbirth.

• Higher levels of red blood cells like in small-for-gestational-age babies (SGA) and some twins.

• Lack of important enzymes.

• Infection

What Groups of Newborns Are Mostly Affected by Neonatal Jaundice?

Mostly, premature babies are very prone to jaundice but according to research, 85% of full-term infants that are less than a month old, also suffer jaundice as it is a very common disease amongst newborns.

Is There a Specific Cycle for Neonatal Jaundice?

The cycle of jaundice, as has been observed, depends on the type of jaundice. But in general terms, full-term infants develop jaundice 2-3days immediately after childbirth which climaxes in 4-5days and then declines in 5-7days. It has a maximum of two weeks in full-term babies. In premature babies, jaundice has a maximum of four weeks. However, pathological jaundice lasts for more than three weeks and has the potential of getting worse.

What Are the General Symptoms of Neonatal Jaundice?

Jaundice mostly begins with fever but the main symptoms of jaundice are the yellow pigmentation of the eyes, skin, and cavity mucous membranes. The urine, sweat, tears also turn yellow. the baby’s stool becomes lighter. There might also be abdominal pain, bloating, anorexia, malaise, nausea and vomiting, diarrhea, or constipation. In extreme situations, liver pain is experienced. The yellowing of the skin symptom always starts from the face and trunk before moving to the downward part of the body. Hemolytic jaundice comes with paler skin due to anemia.

Can Neonatal Jaundice Be Prevented?

To some extent, jaundice is very common, and preventive measures are not so popular, but they include;

• For the first several days after childbirth, feed the baby 8-12 times a day.

• Pregnant women should be tested for blood type and other antibodies.

• On the first day of birth, the bilirubin level of the baby should be checked.

• There should be a revisit to the hospital within the first week of life.

What Diseases Can Be Developed From Jaundice If Not Treated Properly?

As stated earlier, yellowing of the skin and eyes can be an indicator of underlying liver and bile issues. Delay in treatment of jaundice can lead to;

• Cerebral palsy

• Deafness

• A brain disease called kernicterus

Must I go to the hospital?

In the case of neonatal jaundice, please go to a hospital as fast as you can! Although it is common, it is not just a simple skin disease or fever but an indication that something serious might be wrong with the baby’s liver or bile. Reach out to a hospital to verify the cause of jaundice for proper treatment.

In Conclusion

Neonatal jaundice is a very common disease that can lead to other severe diseases if treatment is delayed. Mothers should be vigilant and attentive to notice any slight symptom. Blood and Rh compatibility tests and going for pre-natal ultrasound scans should be emphasized to prevent and handle jaundice effectively.

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