Have you seen a new born baby who was put in the bassinet or an incubator and is exposed to a type of florescent light that is absorbed by the baby’s body because the baby’s skin and white of eye was yellowish in colour after birth? That is a disease condition known as Neonatal Jaundice.
Neonatal Jaundice, New-born Jaundice, or Infant Jaundice is the yellowish discolouration of a new born baby’s skin or the white part of the eye (sclera) due to high level of bilirubin (a yellowish compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates). The elevation of the concentration of bilirubin in the body is also referred to as hyperbilirubinemia.
There are several types of neonatal jaundice based on how the condition develops. Neonatal jaundice is common among babies who were born before the completion of the gestation period and it is arguably the highest reason for admission of new born babies in hospitals. The exact cause of neonatal jaundice may be different in each baby. The discolouration sometimes begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.
Causes of Neonatal Jaundice
Neonatal jaundice is majorly caused by an increase in bilirubin production due to an increase in the breakdown of the fetal erythrocyte (haemolysis). Fetal erythrocytes (red blood cells) are short-lived and this causes an accumulation of bilirubin in the liver due to the fact that a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some cases, an underlying disease may cause jaundice.
Normally, it is the liver’s function through some metabolic pathways to filter bilirubin from the bloodstream and release them into the excretory system for excretion. The inability to conjugate and excrete this bilirubin as quickly as the adult’s liver does, results to its accumulation. Jaundice due to these normal new-born conditions is called physiologic jaundice, and it typically appears on the second or third day of life.
If the neonatal jaundice does not clear up with simple phototherapy, other causes such as biliary atresia, progressive familial intrahepatic cholestasis, bile duct paucity, Alagille syndrome, alpha 1-antitrypsin deficiency, and other paediatric liver diseases should be considered.
Other causative factors include;
- An infection of the baby’s ear such as sepsis
- Internal bleeding (hemorrhage)
- Other viral or bacterial infections
- An incompatibility between the mother’s blood and the baby’s blood (immune mediated).
- An enzyme deficiency (enzymes that catalyse the conjugation of bilirubin).
Picking Up The Symptoms and Diagnosis
The primary symptom of neonatal jaundice is the yellowish discolouration of the sclera and the skin. Other symptoms include poor feeding and excess sleepiness.
Diagnosis is mostly through the measurement of blood bilirubin level. Bilirubinometer which is a device, measures the reflection of a special light shone through the skin can be used to diagnose neonatal jaundice. Diagnosis is best carried out by trained professionals.
How Neonatal Jaundice is Treated
Mild state of neonatal jaundice often disappears on its own after a week or two. For moderate and severe cases, parents are often advised to keep their baby admitted in the hospital or nursery for medical attention which may include phototherapy. The bilirubin levels for initiation of phototherapy varies depending on the age and health status of the new-born.
However, any new-born with a total serum bilirubin greater than 359 μmol/l (21 mg/dL) should receive phototherapy. Intravenous immunoglobulin (IVIg) may be administered for the cases where the haemolysis is caused by the interaction of mother and child’s blood. In this case, the antibodies of the mother triggers haemolysis of the child’s blood. This treatment would introduce a blood protein that can reduce the levels of antibodies in the system.
Rarely, when severe jaundice doesn’t respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood from the baby’s body. The bilirubin and maternal antibodies are diluted, and then the donor’s blood or plasma is transferred back into the baby. This is a delicate procedure that is necessarily carried out within intensive care units. This is a process which corrects immune mediated haemolysis.
Complications That Could Arise
The possible complications that may arise from high levels of bilirubin (hyperbilirubinemia) includes palsy, deafness and kernicterus, also known as chronic bilirubin encephalopathy which is a bilirubin induced brain damage. The only effective way for preventing kernicterus is phototherapy and exchange transfusion which will lower the amount of bilirubin in the body of the baby.
- “Neonatal Hyperbilirubinemia” Merck Manuals Professional Edition. August 2015. Retrieved 11 December 2017.
- Neonatal jaundice – Southern Illinois University School of Medicine
- Lucey, J; Ferriero, M; Hewitt, J (June 1968). “Prevention of hyperbilirubinemia of prematurity by phototherapy”. Pediatrics. 41 (6): 1047–54