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3.5 Minute

19-07-2024 Team Medicover public-health

Written by Medicover Team and Medically Reviewed by Dr Vijay Krishna K

Monitoring Jaundice Levels in Newborns

Jaundice is a common condition in newborns, affecting many infants within their first week of life. It occurs when there is a high level of bilirubin in the blood, causing yellowing of the skin and eyes. While jaundice is often harmless, it’s crucial to monitor and understand jaundice levels to ensure the health and safety of the newborn.

In this article, we will delve into the different types of bilirubin, how jaundice is screened and treated, and the risk factors and symptoms associated with severe neonatal jaundice.

What Is Bilirubin?

Bilirubin is a yellow chemical that occurs naturally in the catabolic pathway that breaks down red blood cells in the body. When red blood cells degrade, they release hemoglobin, which is then transformed to bilirubin. The liver processes bilirubin, and it eventually excretes from the body.

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There are two main types of bilirubin:

Indirect Bilirubin

Indirect bilirubin, also known as unconjugated bilirubin, is the form that the liver has not yet processed high levels of indirect bilirubin can indicate that the liver is not processing bilirubin efficiently, which is common in newborns whose liver functions are still developing.

Direct Bilirubin

Direct bilirubin, also known as conjugated bilirubin, is the form that has been processed by the liver and is ready to be excreted from the body. Elevated levels of direct bilirubin may indicate liver disease or bile duct obstruction.

Jaundice Screening in Infants

Screening newborns for jaundice is a crucial step in ensuring their health and well-being. It typically involves a combination of visual assessments and blood tests to measure bilirubin levels.

Visual Assessment

A healthcare provider will examine the newborn’s skin and eyes for yellowing. This is usually done in

natural light, as artificial lighting can affect the appearance of jaundice.

Bilirubin Tests

Blood tests measure the levels of bilirubin in the newborn’s blood. These tests can determine whether the bilirubin levels are within a normal range or require further monitoring and treatment.

Jaundice Levels in Newborns

The levels of bilirubin in the blood will determine the severity of jaundice and the necessary treatment. Here’s a general guideline for understanding bilirubin levels:

Normal levels: Less than 5 mg/dL
Mild jaundice: 5-12 mg/dL
Moderate jaundice: 12-20 mg/dL
Severe jaundice: Greater than 20 mg/dL

Severe Neonatal Jaundice

Severe neonatal jaundice is a serious condition that requires immediate medical attention. High levels of bilirubin can result in a condition called kernicterus, which can cause permanent brain damage. It’s essential to monitor jaundice levels closely and seek treatment if bilirubin levels are dangerously high.

Jaundice Symptoms

Symptoms of jaundice in newborns can vary, but the most common signs include:

Yellowing of the skin and eyes
Poor feeding or difficulty breastfeeding
Lethargy or excessive sleepiness
Dark urine
Pale or clay-coloured stools

If you notice any of these symptoms in your newborn, it’s essential to contact a healthcare provider immediately.

Jaundice Treatment

Treatment for infant jaundice is determined by the severity of the disease and bilirubin levels. Common treatments include:

Phototherapy

Phototherapy is the most popular treatment for jaundice. It involves exposing the newborn to unique blue spectrum lights that help break down bilirubin in the skin. This treatment is usually done in a hospital but can sometimes be administered at home with the right equipment.

Exchange Transfusion

An exchange transfusion may be necessary in severe cases of jaundice. This procedure involves replacing the newborn’s blood with donor blood to reduce bilirubin levels quickly. Exchange transfusion is typically reserved for the most severe cases of jaundice.

Intravenous Immunoglobulin (IVIg)

For newborns with blood type incompatibility, intravenous immunoglobulin (IVIg) may be used to reduce bilirubin levels. IVIg helps decrease the breakdown of red blood cells, thereby lowering bilirubin levels.

How to Reduce Jaundice Levels in Newborns

Managing newborn jaundice involves a combination of observation, supportive care, and medical intervention.

1. Phototherapy

The most common treatment for high bilirubin levels.
The baby is placed under blue light, which helps break down bilirubin through the skin.
May be performed in hospitals or at home using fiber-optic blankets.

2. Frequent Feeding

Ensures regular bowel movements to eliminate bilirubin through stool.
Breastfeed at least 8–12 times per day; supplement with formula if needed.

3. Intravenous Fluids or Exchange Transfusion

For severe jaundice unresponsive to phototherapy.
Exchange transfusion replaces the baby’s blood with donor blood to quickly reduce bilirubin.

4. Sunlight Exposure (Mild Cases Only)

Indirect sunlight can help reduce bilirubin but must be used cautiously due to risk of overheating or sunburn.

Jaundice Risk Factors

Certain factors can increase the risk of jaundice in newborns, including:

Premature birth: Babies born before 37 weeks of gestation have underdeveloped livers, which can lead to higher bilirubin levels.
Bruising during birth: Babies who experience bruising during delivery may have higher bilirubin levels due to the breakdown of red blood cells.
Blood type incompatibility occurs when the mother and newborn have different blood types, the baby may develop jaundice as the mother’s antibodies attack the baby’s red blood cells.
Breastfeeding issues: Difficulty with breastfeeding can lead to dehydration and lower caloric intake, both of which can increase bilirubin levels.

Preventive Tips for Jaundice in Newborns

Start breastfeeding early and often.
Watch for feeding difficulties.
Ensure regular wet diapers and stools.
Attend all postnatal check-ups.
Ask for bilirubin testing before hospital discharge.

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Conclusion

Understanding jaundice levels in newborns is crucial for ensuring their health and safety. By monitoring bilirubin levels, recognizing symptoms, and seeking appropriate treatment, parents and healthcare providers can effectively manage and treat jaundice in infants. Always consult with a healthcare provider if you have concerns about your newborn’s jaundice levels or overall health.

Frequently Asked Questions

Yes, in some cases the yellow tint may not be easily visible, especially in babies with darker skin tones. In such situations, bilirubin levels are confirmed through a blood test or transcutaneous bilirubinometer. It’s essential to rely on medical evaluation rather than visual cues alone.

Newborns with high bilirubin may be unusually sleepy and harder to wake for feeds. This can lead to dehydration and worsen jaundice if not addressed. Frequent feeding and alerting the pediatrician to lethargy are important steps.

While maternal nutrition doesn't directly cause jaundice, poor fetal growth or complications during pregnancy can increase the risk. Conditions like diabetes or Rh incompatibility can lead to increased red cell breakdown in newborns. Good prenatal care can help reduce such risks.

No, jaundice itself is not infectious or contagious. It is a physiological or medical condition related to the baby's liver or red blood cells. However, if jaundice is caused by an underlying infection, that infection might be transmissible depending on the cause.

Most cases of mild jaundice clear up within 1 to 2 weeks without any treatment. For breastfed babies, it may persist a bit longer but still remain harmless. If bilirubin levels are high, phototherapy may accelerate the resolution process.

Yes, in some cases, jaundice can rebound, especially after phototherapy is stopped. This is known as “rebound hyperbilirubinemia.” Follow-up bilirubin testing ensures levels stay within a safe range post-treatment.