Why do some newborns develop jaundice?

December 30 07:43 2020 Print This Article

Neonatal or newborn jaundice is a common occurrence. This happens due to the accumulation of bilirubin in the blood. Red Blood Cells are replenished constantly by the body. As old RBCs are broken down, a yellow pigment called bilirubin is released into the blood. The liver filters bilirubin and eliminates it through the urine and stools. However, in a newborn baby, this process does not happen smoothly, causing neonatal jaundice. The skin, eyes, and urine of the baby turn yellow, as it happens with anybody afflicted by jaundice.

There are 3 types of neonatal jaundice.

 Types

• Physiologic jaundice: The liver of a new-born is not well developed. So it cannot process the bilirubin fast enough. At the same time, a newborn shows rapid development, so red blood cells are produced and broken down at a rapid pace. Both these factors contribute to bilirubin accumulation in the blood. This is generally seen from the 3^rd day onwards. This is a natural phenomenon and will go away on its own by the 10^th or latest 14^th day, peaking in between around the 7^th
• Breast-feeding jaundice: This happens when the baby is not feeding on the breast-milk adequately or the mother is not producing enough milk. This causes dehydration in the baby. Further, the liver is not getting enough nutrition to breakdown the bilirubin. Both these factors contribute to jaundice. This starts on the 3^rd day and goes away on its own when the mother starts producing more milk, or the baby is feeding well on mother’s milk or formula food.
• Breast-milk jaundice: This happens when some substances in the mother’s milk impair the proper breakdown of bilirubin by the baby’s liver. This condition starts around the 3^rd day and may last up to a week or in rare cases a month. The condition may go away on its own as the baby’s liver develops. If this does not happen, oral medicines are given to correct the condition.

When you should be worried…

In all the above 3 types, the jaundice is mild or moderate with no cause for worry. These are expected, but the doctor will still order for the following tests to be done on the baby. Skin and blood tests are done to check for bilirubin levels, along with tests to determine Complete Blood Count (CBC), blood type and RH incompatibility. Coombs test may also be done to detect excessive breakdown of RBCs by the body. The doctors will be constantly monitoring the baby for 3 days before discharging. After discharge, parents and family must watch the baby closely for up to a month in case jaundice turns severe. This is seen as deepening of the yellow colour in the skin, eyes, and urine.

In some babies, this is precisely what happens. The jaundice turns severe in which case; there is excess bilirubin accumulation in the blood, the condition being called as hyperbilurubinemia. The child shows one or more of the following symptoms:

Symptoms

• The baby’s skin and whites of the eyes are a deep yellow
• The skin on the baby’s hands, legs and tummy is yellowish
• The baby is restless, lethargic or difficult to wake up
• The baby is not feeding well and not gaining weight
• The baby is crying in a shrill or high-pitched voice
• The baby has fever of over 100^oF
• The baby keeps arching its head and neck, back, repeatedly

Underlying causes

There can be several factors contributing to this. Some of them are:

• Haemorrhage or bleeding inside the baby’s body
• There is a sepsis or infection in the baby’s blood
• The baby has one or more viral or bacterial infections such as rubella and syphilis
• The baby’s bile ducts are scarred or blocked, a condition known as Biliary atresia
• Other bile duct conditions such as cystic fibrosis or hepatitis
• Hypoxia or low oxygen level in the baby’s blood
• Deficiency of certain enzymes in the baby
• Some other malfunction in the liver that is causing abnormal breakdown of RBCs
• Certain medicines being consumed by the mother
• Blood disorders such as sickle cell anaemia in the baby
• Various genetic or inherited conditions

Risk factors

So what kind or babies are at the risk of this condition?

• Premature birth: The liver of a baby born before 38 weeks of pregnancy is even less developed than that of a baby born full-term. Further, these babies feed less and have fewer bowel movements. Both these factors cause bilirubin accumulation in the blood.
• Bruising during birth: While mild bruising during birth is natural, some babies may get bruised even more, causing excess production and breakdown of RBCs, leading to jaundice. The bleeding or bruising happens in the scalp (cephalohemotoma).
• Blood-type mismatch: If the mother’s and baby’s blood are different (Rh or ABO incompatibility), certain antibodies from the mother can get passed on to the baby through the placenta. These antibodies may be causing abnormal breakdown of RBCs.
• Race: Generally, babies born of parents with East-Asian ancestry are at a higher risk of this condition.

Complications

The hyperbilirubinemia can cause 2 complications:

1. The excess bilirubin in the blood enters the brain causing damage to brain tissues. Prompt treatment can reverse or restrict the damage. The condition is called acute bilirubin encephalopathy
2. If treatment has been delayed or not given properly, there is permanent damage to brain tissues, the condition being called Kernicterus. The baby shows or will show signs such as uncontrolled or involuntary movements (athetoid cerebral palsy), loss of hearing, tooth enamel not getting developed and the baby having a permanent, upward gaze.

Treatment options

For mild or moderate jaundice, the best treatment and preventive measure is to ensure the baby is fed well. For the first week of the baby’s life, it must be fed mother’s milk every 1 and half hours. Infants on formula food must be fed every 2 and half hours.

For infants suffering from hyperbilirubinemia in the early stage, one or both of the following treatments may be provided:

• Phototherapy: In this, the baby is laid on a special bed. There is blue light of a certain frequency shone from above as well as below using optic fibres. This helps breakdown the bilirubin into a form that the liver can process easily.
• Exchange transfusion: In this, the baby’s blood is removed from its blood vessels using a catheter and replaced with blood from a matching donor. This will reduce the jaundice to a mild or moderate one, and eventually eliminate it.

Conclusion

 Neonatal jaundice is a natural occurrence that happens with almost all babies. There is no cause for worry and the condition will go away soon. However, if the jaundice turns severe, or lasts longer than usual, it is cause for concern. The family should reach out to a reputed hospital immediately. Such hospitals have the best paediatricians on their rolls, some of whom are experts in liver disease. These doctors will design a course of treatment for quick recovery that will ensure the baby develops healthily and normally.

Please contact our 24×7 Dedicated Liver Helpline: Ph: +91 73736 53653 for immediate advice and queries related to liver disease and transplantation.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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