Neonatal Jaundice: Types, Causes, Symptoms, Diagnosis, Prevention, and Treatment
Introduction
Neonatal jaundice is a common condition affecting newborns, particularly in the first week of life. Characterized by a yellowish discoloration of the skin and eyes, neonatal jaundice results from elevated levels of bilirubin in the blood. While in most cases it is harmless and resolves on its own, it can occasionally signal a more serious underlying condition or lead to complications if not managed appropriately.
This article provides an in-depth look at neonatal jaundice, including its types, causes, signs and symptoms, diagnosis, prevention strategies, and treatment options. This guide is designed to help parents, caregivers, and healthcare professionals understand and manage neonatal jaundice effectively.
What is Neonatal Jaundice?
Neonatal jaundice, also known as infant jaundice, occurs when a baby’s liver is not mature enough to eliminate bilirubin efficiently. Bilirubin is a yellow pigment produced during the normal breakdown of red blood cells. When bilirubin builds up in the baby’s bloodstream, it leads to jaundice.
Key Facts:
• Affects over 50% of full-term newborns.
• Commonly appears between day 2 and day 5 after birth.
• Usually resolves without treatment in mild cases.
Types of Neonatal Jaundice
There are several types of neonatal jaundice, classified based on cause, timing, and underlying conditions:
1. Physiological Jaundice
• Most common type.
• Appears between 2-5 days after birth.
• Caused by immature liver function and high red blood cell turnover.
• Resolves without treatment within 1-2 weeks.
2. Pathological Jaundice
• Occurs within the first 24 hours of life.
• Often more severe and long-lasting.
• Caused by underlying conditions like hemolytic disease, infections, or liver disorders.
• Requires immediate medical attention.
3. Breastfeeding Jaundice
• Occurs in the first week of life due to inadequate breastfeeding.
• Leads to dehydration and reduced bilirubin excretion.
• Improved feeding usually resolves the issue.
4. Breast Milk Jaundice
• Starts after the first week and can persist for several weeks.
• Thought to be caused by substances in breast milk that affect bilirubin processing.
• Baby continues to feed well and grow normally.
5. Hemolytic Jaundice
• Due to blood group incompatibility (e.g., Rh or ABO incompatibility).
• Leads to rapid breakdown of red blood cells.
• Requires close monitoring and treatment.
6. Infectious Jaundice
• Caused by neonatal infections like sepsis or TORCH infections.
• Presents with other signs of illness.
• Needs prompt antibiotic treatment and supportive care.
Causes of Neonatal Jaundice
The primary cause of jaundice in newborns is an elevated bilirubin level. Several physiological and pathological factors can contribute:
Physiological Causes:
• Immature liver enzyme system
• High red blood cell turnover
• Decreased bilirubin elimination
Pathological Causes:
1. Blood Group Incompatibility (ABO or Rh)
2. Genetic disorders (e.g., G6PD deficiency)
3. Infections (e.g., sepsis, TORCH)
4. Liver diseases (e.g., biliary atresia, hepatitis)
5. Internal bleeding (e.g., cephalohematoma)
6. Enzyme deficiencies affecting red blood cell survival
Signs and Symptoms of Neonatal Jaundice
The most noticeable sign of neonatal jaundice is the yellowing of the skin and eyes. The extent and severity may vary.
Common Symptoms:
Yellow discoloration starting from face and moving to chest, abdomen, arms, and legs
• Yellowing of the sclera (white part of the eyes)
• Poor feeding or lethargy (in severe cases)
• High-pitched crying
• Dark yellow urine (unusual in newborns)
• Pale or clay-colored stools (may indicate liver issues)
• Note: In severe cases, high bilirubin levels can lead to kernicterus, a type of brain damage that may result in permanent neurological deficits.
Diagnosis of Neonatal Jaundice
Physical Examination:
Doctors assess the baby’s skin tone under natural light and check for signs of yellowing.
Bilirubin Level Measurement:
1. Transcutaneous Bilirubinometer: Non-invasive device placed on the skin.
2. Serum Bilirubin Test: Blood test to measure exact bilirubin levels.
Additional Tests (if necessary):
• Blood type and Coombs test (for blood group incompatibility)
• Complete blood count (CBC)
• Liver function tests
• G6PD levels
• Infection screening (if sepsis or TORCH is suspected)
Prevention of Neonatal Jaundice
While not all cases can be prevented, some proactive steps can help reduce the risk or severity of jaundice in newborns:
1. Adequate Feeding
• Frequent breastfeeding (8–12 times/day) ensures hydration and helps in bilirubin excretion.
• In formula-fed babies, ensure regular and sufficient intake.
2. Monitor at-Risk Babies
Babies with blood group incompatibility, prematurity, or family history of jaundice should be closely monitored.
3. Timely Medical Checkups
• Follow-up visits within 48–72 hours after hospital discharge.
• Early bilirubin screening for at-risk infants.
4. Rh Immunoglobulin (RhoGAM)
• Given to Rh-negative mothers during pregnancy and after delivery if the baby is Rh-positive.
• Prevents Rh incompatibility in future pregnancies.
Treatment of Neonatal Jaundice
Treatment depends on the bilirubin level, the baby’s age (in hours), the underlying cause, and whether the baby is preterm or full-term.
1. Phototherapy
• Most common treatment for neonatal jaundice.
• Uses special blue light to break down bilirubin in the skin.
• Non-invasive and safe.
How it works:
Converts bilirubin into a water-soluble form that can be excreted through urine and stool.
2. Exchange Transfusion
• Used for severe jaundice or if phototherapy fails.
• Baby’s blood is replaced with donor blood to rapidly reduce bilirubin.
• Requires NICU setting.
3. Intravenous Immunoglobulin (IVIG)
• Used in hemolytic jaundice due to blood group incompatibility.
• Reduces the need for exchange transfusion.
4. Treat Underlying Conditions
• Antibiotics for infections
• Treating liver disease or metabolic conditions
5. Discontinuing Breastfeeding (Temporary)
• Rarely needed in breast milk jaundice if bilirubin levels are very high.
• Resume breastfeeding after bilirubin drops.
Complications of Untreated Jaundice
If not treated properly, high levels of bilirubin can lead to serious complications:
1. Kernicterus
A type of brain damage caused by bilirubin crossing the blood-brain barrier.
Symptoms: seizures, poor feeding, muscle stiffness or floppiness, hearing loss, developmental delays.
2. Acute Bilirubin Encephalopathy
• Early stage of kernicterus.
• Reversible if treated early.
3. Neurological Impairments
• Hearing loss
• Cerebral palsy
• Learning disabilities
When to Seek Immediate Medical Attention
Parents and caregivers should contact a healthcare provider if the baby:
• Develops yellowing in the first 24 hours
• Has deepening yellow color over time
• Is not feeding well
• Is excessively sleepy or difficult to wake
• Has dark yellow urine or pale stools
• Shows signs of illness like fever or vomiting
FAQs About Neonatal Jaundice
1. Is neonatal jaundice common?
Yes, it affects over 50% of full-term and 80% of preterm babies.
2. Can jaundice harm my baby?
Most cases are mild and resolve on their own. However, untreated severe jaundice can lead to brain damage.
3. How long does neonatal jaundice last?
Physiological jaundice usually resolves within 1-2 weeks. Breast milk jaundice can last up to 12 weeks but is typically harmless.
4. Is sunlight helpful for jaundice?
Indirect sunlight may help mild jaundice but is not a substitute for phototherapy.
5. Can formula feeding prevent jaundice?
Feeding—either breast or formula—helps reduce bilirubin by promoting bowel movements. Adequate feeding is key.
Conclusion
Neonatal jaundice is a common and typically harmless condition that occurs due to the immature liver’s inability to process bilirubin effectively. While most cases are physiological and self-limiting, it is important to recognize the signs early, monitor bilirubin levels, and intervene when necessary to prevent serious complications like kernicterus.
Understanding the different types of jaundice, their causes, and treatment options ensures better outcomes for newborns. With timely medical care, most infants recover completely without any long-term effects.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)