Diseases

Some degree of jaundice in newborns is normal and not entirely preventable. However, the prevention of significant hyperbilirubinemia and its complications is possible through proper screening (obtaining bilirubin levels), identifying newborns at high-risk, close surveillance and monitoring of those infants with hyperbilirubinemia, parent education, and prompt treatment when deemed medically indicated.

Neonatal jaundice can be diagnosed by examining the newborn and obtaining a blood test to check the total serum bilirubin level. Your health care professional should closely follow your newborn for the development of jaundice, and many hospitals routinely check total bilirubin levels on newborns prior to hospital discharge. Though the blood test is the most accurate, in certain instances, a transcutaneous bilirubin reading can be obtained by placing a handheld sensor against the newborns skin. If this reading is high, a blood test may be ordered to confirm the total bilirubin level. Bilirubin levels are usually highest at 3 of 5 days of life. Additional blood tests may be ordered for those newborns who require treatment and monitoring, or for those who may have other underlying conditions thought to be causing neonatal jaundice.

The complications associated with neonatal jaundice occur when bilirubin levels reach toxic levels, and the bilirubin gets into the central nervous system and damages the brain. The brain toxicity can either be reversible (early acute bilirubin encephalopathy) or the damage may be permanent and irreversible (kernicterus). Permanent damage may lead to cerebral palsy, deafness, and intellectual impairment.

Approximately 60% of all newborns develop jaundice; however newborns with certain risk factors are at higher risk for developing neonatal jaundice. Risks factors include the following:

• Having siblings who have had neonatal jaundice
• Having parents of East Asian or Mediterranean descent
• Preterm babies
• Newborns with feeding difficulties/poor feeding
• Mother with diabetes
• Newborns with bruising/cephalohematoma
• Blood type incompatibility
• Congenital infection

Neonatal jaundice may be associated with various symptoms, depending upon the degree of elevation in bilirubin levels as well as the exact cause of the jaundice. The yellow discoloration of the skin will begin on the face and forehead and extend toward the feet as the levels of bilirubin increase. This characteristic progression of jaundice in infants can sometimes allow your health care professional to estimate the bilirubin level based on the location and extent of the jaundice, though this assessment can often be inaccurate. The signs and symptoms associated with neonatal jaundice may include the following:

• Yellow discoloration of the skin, mucous membranes and the whites of the eyes
• Light-colored stool
• Poor feeding
• Lethargy/excessive sleepiness
• Changes in muscle tone (either listless or stiff with arching of the back)
• High-pitched crying
• Seizures

Kernicterus, which is caused by prolonged excessively elevated levels of bilirubin affecting the central nervous system, must be recognized and promptly treated as it can lead to permanent brain damage. Kernicterus is an irreversible and chronic condition which can include cerebral palsy, hearing loss, and intellectual impairment. Kernicterus has likely started to develop if the infant begins to exhibit extreme lethargy, changes in muscle tone, and a high-pitched cry.

Jaundice is caused by the accumulation of bilirubin in the blood, typically from an increased production of bilirubin or a decreased ability to metabolize and excrete it. Bilirubin is formed when red blood cells break down and is normally metabolized in the liver and excreted in urine and feces. Neonatal jaundice can be caused by several different conditions, and it is very commonly seen in newborns. The most common cause in newborns is physiologic jaundice, which affects most newborns and is usually benign. However, there are many other causes of neonatal jaundice that can be more serious, and require further medical evaluation and intervention. A newborn that develops jaundice within the first 24 hours of life requires immediate medical attention. The following are some of the causes of neonatal jaundice.

Generally speaking, the prognosis for newborns with jaundice is excellent if they receive the appropriate monitoring and treatment, and the vast majority of infants with neonatal jaundice will improve with no adverse effects. However, health care professionals need to remain vigilant and parents need be informed and educated about the potential dangers of severe hyperbilirubinemia in order to prevent the devastating consequences of kernicterus.

The need to treat jaundice in newborns is determined by interpreting the total bilirubin level in relation to the newborns age in hours. If the level is deemed to be too high, or if it is rising too quickly, treatment is necessary. Sometimes, all that is needed for treatment is close monitoring of the bilirubin levels, and no further interventions may be necessary. In certain instances, treatment for neonatal jaundice can occur at home, while in other cases, admission to a hospital is necessary. Based on the total bilirubin level, the underlying cause leading to jaundice, and the newborns clinical condition, various treatment modalities are available to treat jaundice in newborns. These include the following:

• Feeding/hydration: By encouraging frequent feeding with breast milk or formula, newborns will produce more stool and urine, and thus eliminate bilirubin more rapidly from the body. Newborns may need to be fed up to 12 times per day, thus ensuring proper hydration and elimination. In certain instances, newborns may require observation in a hospital to receive intravenous fluids and closer monitoring of bilirubin levels.
• Phototherapy: This treatment is the most common for newborns requiring medical treatment for neonatal jaundice. Phototherapy (light treatment) involves placing the newborn under artificial blue lights with the baby undressed (wearing only a diaper) and using a special mask to protect the eyes. This treatment may occur in an open bassinet or warmer, or sometimes with a phototherapy blanket. These special lights work by converting bilirubin to lumirubin through a chemical reaction that occurs when the newborns skin is exposed to these special lights. This allows the newborn to more easily eliminate bilirubin from the body. Care needs to be taken to avoid excessive heat and dehydration. Phototherapy is used in hospitals, and in certain cases, newborns may be treated at home with phototherapy. Generally speaking, phototherapy is very safe and effective, and this treatment is successful for almost all newborns who require it. Phototherapy treatment is stopped once the newborns closely monitored bilirubin levels have decreased to appropriate values.
• Exchange transfusion: This urgent treatment is used in newborns with severe jaundice who may have failed phototherapy treatment or in those who are at higher risk of developing or have signs of kernicterus. During an exchange transfusion, the newborns blood is replaced with donated blood to rapidly decrease bilirubin levels. It is a more specialized procedure that is used on a case-by-case basis.
• Intravenous immunoglobulin: Administering this treatment may be used in select cases of significant neonatal jaundice due to maternal-fetal blood group incompatibility, and it may in some cases reduce the need for an exchange transfusion.