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3.4 Minute

01-08-2024 Team Medicover pediatrics

Written by Medicover Team and Medically Reviewed by Dr Udaya Keerthi Kanna, Pediatrician

Neonatal Jaundice: Causes, Symptoms, and Treatment

Neonatal jaundice is a common condition in newborns, marked by the yellowing of the skin and eyes due to elevated bilirubin levels in the blood. While often harmless, it can sometimes indicate serious underlying problems that require prompt medical attention.

What Is Neonatal Jaundice?

Neonatal jaundice is the yellowing of a newborn’s skin and eyes due to excess bilirubin in the blood. It is one of the most common conditions in jaundice in newborns, usually appearing in the first two weeks of life.

There are two main types:

Physiological Jaundice – Common and harmless; resolves within 1–2 weeks.
Pathological Jaundice – More serious; appears within the first 24 hours, rises rapidly, or persists longer than two weeks.

Jaundice occurs when bilirubin, a yellow pigment formed during the breakdown of red blood cells, builds up in the blood.

Jaundice in newborns is common because their livers are still immature and may not process bilirubin efficiently.
Mild forms, such as physiological jaundice, typically appear within 2–4 days after birth and resolve within 1–2 weeks.
Severe or early-onset jaundice, known as pathological jaundice, appears within the first 24 hours and requires urgent evaluation.

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Neonatal Jaundice Causes

Neonatal jaundice causes can be divided into physiological and pathological:

Physiological Causes
- An immature liver is unable to process bilirubin efficiently
- Increased breakdown of red blood cells in newborns
Pathological Causes (Pathological Jaundice)
- Blood group incompatibility (Rh or ABO incompatibility)
- Liver diseases like biliary atresia (bile flow obstruction)
- Infections (sepsis, TORCH infections)
- Enzyme deficiencies like G6PD deficiency
- Prematurity – higher risk due to an underdeveloped liver
Other Factors
- Poor feeding or dehydration
- Genetic or metabolic disorders
- Birth injuries leading to excess blood breakdown (cephalohematoma)

Note: Jaundice appearing in the first 24 hours is usually pathological and requires urgent medical care.

Neonatal Jaundice Symptoms

Recognising neonatal jaundice symptoms early is crucial for timely treatment.

Yellowing of the Skin and Eyes (Sclera)
Dark Urine (stains diapers)
Pale or Clay-Colored Stools
Poor Feeding or Refusal to Feed
Lethargy or Excessive Sleepiness
Irritability

If the baby develops these signs, a pediatrician should be consulted immediately.

Diagnosis of Jaundice in Newborns

Doctors diagnose jaundice in newborns using:

Physical Examination: The healthcare provider checks for yellowing of the skin and eyes.
Medical History: Reviewing the baby's birth history and any relevant family health issues.
Serum Bilirubin Test: Measures direct and indirect bilirubin
Direct bilirubin normal range: 0.1 to 0.4 mg/dL
Blood Type & Coombs Test: Detects blood group incompatibility
Complete Blood Count (CBC): Checks for anemia or infection
Liver Function Tests and Ultrasound: For prolonged jaundice or suspected liver disease
Transcutaneous Bilirubinometer: Non-invasive bilirubin check for newborns older than 24 hours

Blood Tests

Serum Bilirubin Test: Measures the level of bilirubin in the blood.
Complete Blood Count (CBC): To check for anaemia or infection.
Blood Type Testing: To identify potential blood group incompatibilities.
Additional Tests: If necessary, further tests might include a direct Coombs test to check for hemolytic disease or liver function tests to assess the liver's health.

A healthcare professional should perform diagnosis and management to determine the underlying cause and appropriate treatment.

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 or older and have reached a gestational age of 35 weeks or more. If there is prolonged jaundice or jaundice within the first 24 hours, the baby should be seen by a Paediatrician, and other tests may be recommended, such as further blood tests, ultrasound scans, and tests for any infections.

Types of Neonatal Jaundice

1. Physiological Jaundice

Appears on day 2–4, peaks by day 5–7, and resolves within 2 weeks
Harmless and usually requires no treatment

2. Pathological Jaundice

Appears within 24 hours of birth
Rapid rise in bilirubin levels
Often due to blood group incompatibility, infections, or liver disease
Needs immediate neonatal jaundice treatment

3. Breastfeeding and Breast Milk Jaundice

Breastfeeding jaundice: Occurs due to inadequate feeding in the first week
Breast milk jaundice: Appears after 7 days due to substances in breast milk that slow bilirubin processing
Both are usually harmless and resolve naturally

4. Prolonged Jaundice

Lasts >14 days in full-term or >21 days in premature babies
Could be benign or indicate underlying liver or thyroid problems

Neonatal Jaundice Treatment

Treatment depends on bilirubin levels, the baby's age, and the underlying cause:

1. Phototherapy for Baby

The most common neonatal jaundice treatment
Uses special light to convert bilirubin into water-soluble forms that can be excreted
Requires eye protection for the baby
Monitored with a bilirubin chart
Effective and safe for both physiological and mild pathological jaundice

2. Exchange Transfusion

Required in severe cases or when bilirubin levels are dangerously high
Removes bilirubin-rich blood and replaces it with donor blood

3. Supportive Care

Increase breast milk or formula feeding to flush out bilirubin
Hydration is essential

4. Treatment for Underlying Conditions

Antibiotics for infection
Surgery or special care for biliary atresia
Medical management for enzyme deficiencies

Prognosis of Neonatal Jaundice

Physiological and breastfeeding jaundice have an excellent prognosis
Pathological jaundice can lead to brain damage (kernicterus) if untreated
Early detection and phototherapy for a baby usually prevent complications.

Note: Atal-Jaundice

In some regions, severe or life-threatening neonatal jaundice is referred to as Atal-jaundice. It highlights the importance of early diagnosis and treatment to avoid fatal outcomes.

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Conclusion

Neonatal jaundice is a common and often harmless condition in newborns, but early monitoring is crucial. Understanding neonatal jaundice causes, identifying neonatal jaundice symptoms, and seeking timely neonatal jaundice treatment with phototherapy for the baby or medical care ensures a healthy recovery.

If jaundice appears within 24 hours, persists beyond two weeks, or is accompanied by poor feeding and lethargy, consult a pediatrician immediately.

No, breastfeeding jaundice is typically caused by inadequate intake, usually within the first week. Breast milk jaundice appears later (after 7 days) and is due to substances in breast milk affecting bilirubin processing.

Frequently Asked Questions

Yes, if jaundice appears within the first 24 hours of life, it's usually pathological and requires urgent attention.

Phototherapy is recommended when bilirubin levels exceed age-specific thresholds or if jaundice is causing feeding difficulty, dehydration, or lethargy.

Yes, dark urine and clay-coloured stools can accompany high bilirubin levels, indicating issues with direct (conjugated) bilirubin.

Severe jaundice, if untreated, can lead to a condition called kernicterus, which may affect brain development and cause lifelong disabilities.

Ensuring regular breastfeeding or formula feeding, monitoring the baby's skin color, and seeking medical advice promptly if jaundice is suspected can help prevent complications.

Jaundice may recur briefly during the first few weeks of life but typically resolves as the baby's liver matures.