An increase in bilirubin in the bloodstream causes jaundice in children, which is characterized by a yellowing of the skin and/or eyes. When hemoglobin (the oxygen-carrying component of red blood cells) is broken down as part of the regular process of recycling old or damaged red blood cells, bilirubin is produced. Bilirubin is taken through the bloodstream to the liver, where it is processed before being expelled as bile (the digestive fluid produced by the liver). Conjugation is the process by which bilirubin is attached to another chemical molecule in the liver.
The bile ducts convey bile into the first part of the small intestine (duodenum). Bilirubin builds up in the blood if it is not digested and eliminated quickly enough by the liver and bile ducts (hyperbilirubinemia). The whites of the eyes turn yellow first, followed by the skin, as bilirubin levels in the blood rise. The majority of full-term newborns acquire unconjugated hyperbilirubinemia within their first week of life, resulting in jaundice that usually fades within a week or two (physiologic jaundice). Premature newborns are more likely to develop jaundice due to unconjugated hyperbilirubinemia.
The bile ducts convey bile into the first part of the small intestine (duodenum). Bilirubin builds up in the blood if it is not digested and eliminated quickly enough by the liver and bile ducts (hyperbilirubinemia). Excess bilirubin accumulates in the skin, the whites of the eyes, and other tissues, turning them yellow (jaundice).
The severity of jaundice is determined by a number of factors.
- What is the cause of jaundice?
- What is the bilirubin level?
- The conjugation or nonconjugation of the bilirubin.
Some jaundice-causing illnesses are harmful regardless of bilirubin levels. Unconjugated bilirubin levels that are extremely high, regardless of the reason, are extremely harmful.
High amounts of unconjugated bilirubin have the most devastating consequences.
Kernicterus is a type of brain disease caused by bilirubin buildup in the brain. Premature babies, those who are extremely ill, and those who are given specific drugs have an increased risk of developing this condition. Kernicterus can cause serious brain injury, which can lead to developmental delays, cerebral palsy, hearing loss, seizures, and even death if left untreated. Although kernicterus is now uncommon, it can almost always be avoided by detecting and treating hyperbilirubinemia early. There is no way to reverse a brain injury once it has occurred.
Causes of Jaundice in Newborns
The following are the most prevalent causes of jaundice in newborns:
- Physiologic jaundice
- Excessive red blood cell breakdown (hemolysis)
There are two causes of physiologic jaundice. First, neonates’ red blood cells break down more quickly than older infants’, resulting in higher bilirubin generation. Second, the liver of a newborn is young, and it cannot digest bilirubin and remove it from the body as effectively as it does in older newborns. Physiologic jaundice affects almost all babies. It usually shows up 2 to 3 days after birth (jaundice that appears in the first 24 hours after birth may be due to a serious disorder). Physiologic jaundice is usually asymptomatic and goes away in a week. If the baby’s jaundice persists after two weeks, doctors will look for additional reasons of hyperbilirubinemia besides physiologic jaundice.
Breastfeeding jaundice appears throughout the first few days of life and usually goes away within a week. It occurs in babies who do not ingest enough breast milk, such as when the mother’s milk has not yet arrived in sufficient quantities. Because these babies have fewer bowel motions, they excrete less bilirubin. Jaundice disappears on its own when neonates continue to breastfeed and ingest more food.
Breast milk jaundice is distinct from breastfeeding jaundice in that it develops near the end of the first week of life and can resolve within two weeks or last for months. Breast milk jaundice is caused by chemicals in breast milk that blocks the liver’s ability to eliminate bilirubin from the body.
Hemolysis (the breakdown of red blood cells) can overload the newborn’s liver, causing it to process more bilirubin than it can handle. Hemolysis can be induced by a variety of factors, which are classified based on whether or not they are caused by an infection.
- Immune disorder
- Nonimmune disorder
Hemolysis is caused by immune diseases in which an antibody in the infant’s blood assaults and destroys the red blood cells. When the fetus’ blood type does not match (is incompatible) with the mother’s, the fetus can die. Rh incompatibility and ABO incompatibility are two types of incompatibilities.
Hereditary deficiency of the red blood cell enzyme glucose-6-phosphate dehydrogenase (G6PD deficiency) and hereditary red blood cell disorders such as alpha-thalassemia are nonimmune causes of excessive red blood cell disintegration. A hematoma is a collection of blood under the skin that develops in newborns who have been wounded during birth. Jaundice can result from the breakdown of blood in a big hematoma. It’s possible that babies delivered to diabetes mothers will receive too much blood from the placenta. Jaundice can be caused by the breakdown of this blood. Increased bilirubin can be caused by the breakdown of transfused blood cells.
Jaundice can be caused by a variety of factors that are less common.
- Severe infections
- An underactive thyroid gland (hypothyroidism)
- An underactive pituitary gland (hypopituitarism)
- Certain hereditary disorders
- Obstruction of bile flow from the liver
Evaluation of Jaundice in Newborns
Doctors evaluate babies for jaundice on a regular basis while they are in the hospital. The color of the whites of the newborn’s eyes or the skin can be a sign of jaundice. However, most doctors check the newborn’s bilirubin level before releasing him or her from the hospital. Doctors focus on evaluating whether the newborn’s jaundice is physiologic and, if not, determining the source so that any harmful causes can be treated. If jaundice persists after two weeks, it is very crucial to have an infant checked for serious problems.
The following symptoms in babies with jaundice are cause for concern:
- The first day of life is marked by jaundice.
- Jaundice in babies older than two weeks
- Lethargy, poor eating, irritability, and breathing difficulties
- Fever is a contagious illness.
When to see a doctor
Newborns who show warning symptoms should be seen by a doctor as soon as possible. If the newborn is released from the hospital the first day after birth, the bilirubin level should be tested within two days of discharge.
If parents discover that their newborn’s skin or eyes become yellow once they get home, they should contact their doctor right once. Based on whether the infant has any symptoms or risk factors such as prematurity, the doctor can determine how urgently the newborn should be evaluated.
What the physician does
Doctors begin by inquiring about the symptoms and medical history of the newborn. A physical examination is next performed by the doctors. What they discover during the history and physical examination frequently points to a cause and the tests that may be required.
Doctors want to know when jaundice started, how long it’s been there, and if the baby has any additional signs like lethargy or poor eating. Doctors want to know what, how much, and how often the baby is fed. They inquire about how effectively the baby latches onto the breast or takes the nipple of the bottle, whether the mother believes her milk has arrived, and whether the baby swallows during feedings and appears pleased afterward. The doctor also inquires about the color of your stool. Doctors can use information about how much urine and feces a newborn generates to determine whether or not the baby is getting enough food. Cholestasis is indicated by pale stools that are not the normal yellow-gold color.
Doctors inquire about the mother’s blood type and medications, as well as any illnesses or disorders she may have had during pregnancy (such as diabetes) that could induce jaundice in the baby. They also inquire about any inherited illnesses that can cause jaundice in family members.
Doctors examine the newborn’s skin during the physical examination to evaluate how far jaundice has spread throughout the body (the lower down on the body that jaundice is visible, the higher the bilirubin level). They also look for other signals that could point to a reason, such as evidence of illness, damage, thyroid disease, or pituitary gland issues.
To establish the diagnosis of jaundice, bilirubin levels are tested, and tests are performed to identify whether any excess bilirubin is conjugated or unconjugated. Levels can be detected in a blood sample or by placing a sensor on the skin.
Other blood tests are performed if the bilirubin level is high. They usually consist of
Hematocrit is a measurement of the number of red blood cells (the percentage of red blood cells in the blood).
A blood sample is examined under a microscope for symptoms of red blood cell disintegration.
Direct Coombs test for reticulocyte count (number of newly formed red blood cells) (which checks for certain antibodies attached to red blood cells).
Different forms of bilirubin are measured.
The newborn’s and mother’s blood types, as well as their Rh status (positive or negative).
Treatment of Jaundice in Newborns
If a condition is discovered, it is addressed as soon as feasible. High bilirubin levels may also necessitate therapy.
- Physiologic jaundice normally doesn’t need to be treated and goes away in about a week. Frequent feedings of formula-fed babies can help avoid or lessen the severity of jaundice. Frequent feedings cause more bowel movements, which eliminates more bilirubin in the stool. It doesn’t appear to matter what kind of formula is used.
Increased feeding frequency can also help to prevent or minimize breastfeeding jaundice. Infants may need to be supplemented with formula if their bilirubin level continues to rise.
In the case of breast milk jaundice, moms may be recommended to stop breastfeeding for 1 or 2 days and feed their newborn formula, as well as express breast milk on a regular basis during this time to maintain their milk supply. Then, as soon as the newborn’s bilirubin level begins to drop, they can resume breastfeeding. Mothers are frequently advised not to offer their newborns water or sugared water during breastfeeding because this may reduce the amount of milk the infant drinks and alter the mother’s milk production. Breastfed babies who get dehydrated despite increased nursing may require supplemental fluids.
“Bili lights” or phototherapy
This is the most common treatment, however, it does not work for all kinds of hyperbilirubinemia. Phototherapy, for example, is not used in newborns with cholestasis. Phototherapy is the use of intense light to convert bilirubin that has not been digested by the liver into a form that can be quickly excreted from the body via urine. The most effective light is blue, and most doctors utilize commercial phototherapy devices. Newborns are placed beneath the device and stripped down to reveal as much flesh as possible. They are turned often and left under the lights for varying amounts of time (usually 2 to 7 days), depending on how much the bilirubin levels in the blood need to be reduced.