What is Newborn Jaundice?

Jaundice in newborns, also known as neonatal jaundice, is a common condition, caused by hyperbilirubinemia (excess production of serum bilirubin). Bilirubin is an orange-yellow pigment formed in the liver by the normal breakdown of old red blood cells (RBCs).

Neonatal jaundice is characterized by turning the infant’s skin and eye color to yellowish and it is the most common cause of readmission for newborn babies.

What are the Causes of Newborn Jaundice?

Elevation in bilirubin in newborns may be due to several reasons:

• Their liver may not be fully developed, especially among preterm newborns, therefore, the metabolism of bilirubin would be slower.
• Premature babies may have feeding and digesting difficulties, resulting in insufficient milk intake.
• Newborns have a shorter lifespan of RBCs, and higher concentration of RBBs, leading to a higher production rate of bilirubin than adults.
• They may have delayed first tar-like stools (meconium), resulting in increased intestinal reabsorption of bilirubin.
• Sickle cell anemia may create abnormal shapes of red blood cells.
• ABO or Rh incompatibility between the mother and baby, resulting in increased breakdown of the baby’s RBCs, thus elevated bilirubin levels. This type needs medical intervention. The sooner the treatment, the better the results are.
• Other causes include medical conditions like rubella, cystic fibrosis, and hypoxia.

What are the Types of Newborn Jaundice?

1. Physiological Jaundice:

Physiological Jaundice is the most common type, especially in the first week of life. The newborn’s immature liver is often the cause of this type, resulting in excess bilirubin. However, it is mild, transient, and resolves without treatment. It usually resolves on its own when the liver matures without causing any complications.

2. Breastfeeding Jaundice:

This type of jaundice occurs in neonates that are breastfed. It usually presents during the first one to two weeks after birth and often resolves spontaneously, however, it may persist for 8 to 12 weeks of life.

The etiology of breast milk jaundice is not well known, nevertheless, it may occur due to reasons in the breast milk itself. Also, genetic mutations in the newborn may be present. Insufficient intake of breast milk and dehydration can also be risk factors, as well. It is recommended to continue breastfeeding to reduce its risk.

3. Breast Milk Jaundice:

This type differs from breastfeeding jaundice and occurs in well-fed newborns, often after the second weeks of life, and may last for a few weeks. It is usually harmless. The mechanism leading to breast milk jaundice is poorly understood; it may be due to substances in the mother’s milk that increase intestinal reabsorption of bilirubin.

How is Newborn Jaundice Diagnosed?

• Physical examination of signs includes checking the baby’s skin and eye color changing to yellow within the first 72 hours of birth.
• Blood levels of bilirubin must be tested through a bilirubinometer and a blood sample.

How is Newborn Jaundice Treated?

In most cases, neonatal jaundice resolves spontaneously. Mild hyperbilirubinemia often returns to normal as the newborn’s liver completes development. Additionally, continuous breastfeeding encourages bowel movement, which helps eliminate excess bilirubin.

Phototherapy (light therapy) is commonly used in cases of high or persistent elevation in bilirubin levels. It is a method of treatment using ultraviolet light on the baby’s skin to help break down bilirubin,  usually taking one to two days.

In rare cases, blood transfusion may be recommended if phototherapy does not work and bilirubin levels need to be reduced quickly.

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