What Is Jaundice?
The build-up of chemicals in the tissues of the body causes jaundice. The chemical called bilirubin is found in the body within RBC (Red Blood Cells) and is broken down and processed by the liver. Jaundice can occur at any time of life, from birth to old age, due to different causes.
In the first two weeks of a baby’s life, neonatal jaundice is most commonly seen, which is mostly not harmful but also could be due to a serious cause that needs treatment. If the jaundice is seen in the first 24 hours of the baby’s life or persists for two weeks of age, then the cause of neonatal jaundice should be investigated.
The skin and whites of the eyes are sites where jaundice can be noticed. Whites of the eyes are more commonly seen, turning yellow, with a mild increase in the level of bilirubin, suspecting jaundice, and if the skin starts turning yellow, which could indicate an increase in jaundice with high levels of bilirubin.
Reasons for jaundice in babies:
As mentioned, the above-increased level of bilirubin in the tissues is the cause of jaundice. Red blood cells are more in newborn babies when compared to adults, and they break down, which leads to the build-up of bilirubin. As the bilirubin is made too quickly, the liver will break it all down, increasing the level of bilirubin.
At the age of two weeks, jaundice disappears in most babies as the breakdown of red blood cells decreases after a few weeks, and also the liver quickly breaks down the bilirubin. Physiological jaundice is the most common cause of jaundice, and it occurs between the second and fourth day of life, increases by the seventh day, and disappears by day 14. Jaundice could be severe if started on the first day of birth if it is severe with a high level of bilirubin if the baby is feeling irritated or not feeding well, and if it is still present after two weeks of birth. It can also be serious if the baby has a liver problem with pale stools and urine causing dark stains in the nappy.
What is prolonged jaundice?
If jaundice lasts for 14 days and even after 14 days of birth or 21 days for premature babies, it is known as prolonged jaundice. It is mostly caused by breastfeeding, and it could also indicate a serious problem. A newborn may become jaundiced while being breastfed, but this is not harmful to the baby and poses no health risks.
Some of the other causes of jaundice include:
Jaundice in newborn babies may also be due to several other causes that could be due to blood, liver diseases like biliary atresia (obstruction of the normal flow of bile from the liver into the gut) or any other problems like infections or blood group incompatibility, which is caused due to reaction of the mother’s blood group with the baby’s blood group which destroys red blood cells in the baby. If the jaundice is present in the first 24 hours of life or the baby seems unwell, it may not be physiological jaundice.
If the baby is affected by jaundice, it is important to meet a Paediatrician before the symptoms worsen. A usual checkup will be done by a Paediatrician after 72 hours of birth. Consult a Paediatrician immediately if the jaundice is seen within 24 hours of birth and stays till 14 days of life and if the baby is unwell.
Tests for Neonatal Jaundice:
A transcutaneous bilirubinometer is used to measure the level of bilirubin. It is placed against the baby’s skin and is used for babies who are 24 hours old and above 35 weeks. If there is prolonged jaundice or jaundice in the first 24 hours, the baby's unwell should be seen by a Paediatrician, and other tests may be recommended, like further blood tests, ultrasound scans, and tests for any infections.
Treatment for Neonatal Jaundice:
Fluid intake should be increased for babies with jaundice. Phototherapy and exchange transfusion could be the treatment options.
- Phototherapy is a light treatment. It uses light to reduce the level of bilirubin. The light waves are absorbed by skin and blood, changing the bilirubin into harmless substances. It is considered the main treatment for jaundice in babies and is preferred if bilirubin levels are too high. To see the level of bilirubin, a chart is used. It is a safe and effective treatment for jaundice. The baby’s skin needs to be exposed as much as possible to light, and eye pads are provided to protect the baby’s eyes. Due to phototherapy, you will have less chance to hold the baby, and the baby will have to stay under the lights. For premature babies and for babies with jaundice within 24 hours of birth, phototherapy may be started very soon.
- Exchange transfusion is needed if bilirubin levels are too high, which involves blood transfusion to decrease the level of bilirubin.
- Other treatments may also be needed if there is any other underlying cause.
Prognosis for Neonatal Jaundice:
For breastfeeding jaundice and physiological jaundice, the prognosis is excellent without any other long-term problems. The prognosis could also differ depending upon the seriousness of the cause of jaundice.
Neonatal Jaundice complications:
There could be serious issues like brain damage causing cerebral palsy and hearing and learning problems in babies if the level of bilirubin is very high.