Newborn (Neonatal) Jaundice: All you need to know

Last Updated on October 17, 2023 by Shabnam Sengupta

Neonatal jaundice, also known as neonatal hyperbilirubinemia, is a common condition that affects newborn babies. It occurs when there is an excessive build-up of bilirubin, a yellow pigment produced when red blood cells break down. Normally, liver processes and eliminates bilirubin. In newborns, the liver may not fully develop and may not be able to process bilirubin efficiently. As a result, the excess bilirubin can accumulate in the blood. Some of the symptoms of neonatal jaundice can be yellowing of the skin and eyes.

Neonatal jaundice is a relatively common condition, affecting up to 60% of full-term babies and 80% of premature babies. It usually appears within the first few days of life. This condition then typically resolves on its own within a week or two without causing any serious long-term health problems. However, in some cases, neonatal jaundice can become severe and may require medical intervention. In this article, we will discuss neonatal jaundice, its symptoms, causes, treatments and cure.

What are the symptoms of neonatal jaundice?

The symptoms of neonatal jaundice are usually mild. They may include yellowing of the skin and whites of the eyes, poor feeding, and lethargy. In some cases, however, the jaundice may become more severe. This can cause the baby to become very sleepy and difficult to wake, or even to have seizures.

The most common symptom of neonatal jaundice is the yellowing of the skin and whites of the eyes. This occurs due to the accumulation of bilirubin in the baby’s blood. Other symptoms of neonatal jaundice may include:

• Poor feeding: Babies with neonatal jaundice may become lethargic and have difficulty feeding.
• Dark urine: The urine of a baby with jaundice may be darker than usual.
• Pale-colored stools: The stools of a baby with jaundice may be pale or clay-colored.
• Irritability: Some babies with jaundice may become irritable and difficult to console.
• Sleepiness: In severe cases of jaundice, babies may become very sleepy and difficult to wake.

It is important to note that many babies with neonatal jaundice may not exhibit any symptoms at all. In such cases, yellowing of the skin and eyes may be the only sign of the condition. This is why it is important for healthcare providers to monitor newborns for signs of jaundice. It is particularly important for babies who have risk factors for the condition.

What causes newborn jaundice or neonatal jaundice?

Neonatal jaundice is a common condition that affects many newborn babies. There are several reasons or risk factors that can increase the likelihood of a baby developing neonatal jaundice. These include certain medical conditions, such as hypothyroidism or glucose-6-phosphate dehydrogenase (G6PD) deficiency.

We do not know the exact cause of neonatal jaundice. However, there are several risk factors that may increase the likelihood of a baby developing the condition. These risk factors include:

Prematurity:

Premature birth can cause newborn jaundice because the liver of a premature baby may not fully develop. This makes it less capable of processing bilirubin. Bilirubin normally travels through the liver and excretes out of the body through the digestive system. However, in premature babies, the liver may not be able to process bilirubin quickly enough. This causes their bilirubin to build up in the bloodstream and leading to a condition called hyperbilirubinemia, or jaundice.

Additionally, premature babies are more likely to experience other factors that can contribute to jaundice. These include an increased breakdown of red blood cells, reduced intake of breast milk or formula, and delayed meconium passage. These factors can also increase the level of bilirubin in the bloodstream, leading to jaundice.

Blood type incompatibility:

Blood type incompatibility can cause jaundice in newborns due to a condition called hemolytic disease of the newborn (HDN). HDN occurs when the mother’s immune system produces antibodies that attack the baby’s red blood cells. This leads to the destruction of the red blood cells and the release of excess bilirubin into the bloodstream.

This can occur when the mother has a different blood type than the baby. For example, if the mother has Rh-negative blood and the baby has Rh-positive blood, the mother’s immune system may produce antibodies against the Rh factor in the baby’s blood. This is called Rh incompatibility.

The first time there is exposure of the mother to the baby’s Rh-positive blood, her immune system may not produce enough antibodies to cause significant damage. However, in subsequent pregnancies with Rh-positive babies, the mother’s immune system may get stronger to produce a greater number of antibodies. This can lead to more severe HDN and jaundice.

Other blood group incompatibilities, such as ABO incompatibility, can also cause HDN and jaundice in newborns. In this case, the mother’s immune system produces antibodies against the baby’s A or B antigen. This will result in destruction of the baby’s red blood cells.

Gestational diabetes:

Gestational diabetes can increase the risk of neonatal jaundice in the baby. It is a condition in which high blood sugar levels develop during pregnancy. When a woman has gestational diabetes, her baby may be at increased risk for certain complications, including neonatal jaundice.

Gestational diabetes can cause an increase in the production of insulin in the baby’s body. Insulin stimulates the breakdown of red blood cells. This can lead to an increase in bilirubin levels and contribute to the development of jaundice.

In addition, babies born to mothers with gestational diabetes may be larger than average. This too increase the risk of neonatal jaundice. Large babies may have a harder time processing bilirubin. This can cause a buildup of the substance in the blood and the development of jaundice.

It is important for pregnant women with gestational diabetes to receive appropriate medical care and monitoring. It will help them to manage their condition and reduce the risk of complications for their baby. This may include monitoring of bilirubin levels and early treatment if neonatal jaundice develops.

Bruising during birth:

Babies who experience significant bruising or trauma during birth may be at a higher risk of developing neonatal jaundice.

Bruising during birth can cause newborn jaundice. It can lead to an increased breakdown of red blood cells. This in turn can increase the level of bilirubin in the bloodstream. Bilirubin is a yellow pigment, produced when red blood cells break down. It is normally processed by the liver and excreted out of the body. However, if there is an excessive breakdown of red blood cells, the liver may not be able to process the bilirubin quickly enough. This will lead to a buildup of bilirubin in the bloodstream and jaundice.

During a difficult birth, the baby may experience pressure or trauma that can cause bruising or other injuries. These injuries can lead to an increased breakdown of red blood cells and the release of excess bilirubin into the bloodstream. This can result in jaundice within the first few days after birth.

Jaundice caused by bruising during birth is usually mild and self-limited, meaning it resolves on its own without treatment.

Breastfeeding:

Breastfeeding can cause mild jaundice in some babies, particularly during the first week of life. It can cause neonatal jaundice causing symptoms like yellowing of the skin and eyes. However, it is usually a temporary and mild condition. Breastfeeding jaundice occurs when the baby does not get enough milk and fluids, leading to dehydration and a buildup of bilirubin in the bloodstream.

Breast milk jaundice, on the other hand, is a less common form of jaundice that occurs in some breastfed babies after the first week of life. A substance in the breast milk that can interfere with the liver’s ability to process bilirubin causes this condition. Breast milk jaundice typically peaks at two to three weeks of age and may last for several months, but it does not cause any long-term health problems.

To prevent breastfeeding jaundice, it is important for breastfeeding mothers to feed their babies frequently and ensure they are getting enough milk and fluids. It is also important to monitor the baby’s weight gain and urine output to ensure they are receiving enough nutrition.

It is important to note that breast feeding has a lot of positive effects on the mother’s and baby’s health. Therefore, you must not stop breastfeeding without the doctor’s advice.

Family history and genetics:

If there is a family history of jaundice, the baby may be more likely to develop the condition.

Genetics can play a role in the development of newborn jaundice in several ways. One of the most common genetic factors is enzyme deficiency that a baby can inherit called glucose-6-phosphate dehydrogenase (G6PD) deficiency. If a baby inherits a deficient G6PD gene from their parents, their red blood cells may be more susceptible to damage and breakdown, leading to an increase in bilirubin levels and jaundice.

Another genetic factor that can contribute to newborn jaundice is hereditary spherocytosis. It is a rare genetic disorder that causes red blood cells to be more fragile and prone to breakdown, leading to an increase in bilirubin levels and jaundice.

Certain ethnic groups, such as those of Mediterranean, African, or Southeast Asian descent, may also be more likely to have genetic factors that increase their risk of developing jaundice.

In addition to inherited genetic factors, some newborns may develop jaundice due to genetic mutations or variations that affect the way their liver processes bilirubin. For example, mutations in the genes that control the production of enzymes involved in bilirubin metabolism can lead to a buildup of bilirubin and jaundice.

Overall, genetic factors can contribute to the development of newborn jaundice. However, many cases of jaundice are mild and self-limited, and you can manage it with proper medical care.

Certain medical conditions:

Certain medical conditions, such as hypothyroidism, can increase the risk of neonatal jaundice.

It is important for healthcare providers to be aware of these risk factors and to monitor newborns for signs of jaundice. With early detection and proper management, doctors can treat most cases of neonatal jaundice successfully.

How is neonatal jaundice detected, measured and monitored in newborn babies?

Neonatal jaundice can be measured and monitored using a device called a bilirubinometer or a transcutaneous bilirubinometer. These devices use light to measure the amount of bilirubin in the baby’s blood. They do this by shining a light on the skin and measuring the amount of light that it absorbs.

In addition to using a bilirubinometer, healthcare providers may also monitor neonatal jaundice by observing the baby’s skin color and checking for signs of dehydration or poor feeding. They may also monitor the baby’s weight and urine output to ensure that the baby is receiving enough fluids and nutrition.

Doctors may monitor the babies who are at higher risk for neonatal jaundice, such as premature babies or those with a family history of jaundice more closely to ensure early detection and proper treatment.

If a healthcare provider suspects that a baby has severe or prolonged jaundice, they may order a blood test to measure the baby’s bilirubin levels more accurately and to rule out any underlying medical conditions that may be causing the jaundice.

It is important for parents to work closely with their healthcare providers to ensure proper monitoring of their baby for neonatal jaundice. They should also seek immediate medical attention if they notice any signs or symptoms of the condition.

How is jaundice in newborn babies treated?

The treatment of neonatal jaundice depends on the severity of the condition. In mild cases, no treatment may be necessary, and the jaundice will usually resolve on its own within a week or two. In more severe cases, doctors may recommend the following treatments:

Phototherapy:

This is the most common treatment for neonatal jaundice. Doctors place the baby under special lights that help to break down the bilirubin in the blood.

Exchange transfusion:

In severe cases of jaundice, where phototherapy is not effective, doctors may recommend an exchange transfusion. This involves replacing the baby’s blood with fresh donor blood.

Fluids and nutrition:

Ensuring that the baby receives enough fluids and nutrition is important, as dehydration and poor nutrition can worsen jaundice.

Treatment of underlying medical conditions:

If the jaundice is a result of an underlying medical condition, such as hypothyroidism or G6PD deficiency, the doctor will need to treat the underlying condition.

Close monitoring:

Babies with jaundice will need to be closely monitored to ensure that the condition is not getting worse and that the baby is receiving appropriate treatment.

It is important for parents to work closely with their healthcare provider to ensure that their baby receives appropriate treatment for neonatal jaundice. With proper treatment, most cases of neonatal jaundice resolve within a few weeks and do not cause any long-term health problems.

How is neonatal jaundice treated at home?

Neonatal jaundice typically requires medical treatment. However, there are some measures that you can take at home to support the baby’s recovery and manage the symptoms of the condition. However, it is important for parents to consult with their healthcare provider before attempting any home remedies or treatments.

Some things that may help manage neonatal jaundice at home include:

Frequent feeding:

Ensuring that the baby is well-fed can help prevent dehydration and promote the excretion of bilirubin in the stool.

Supplemental feedings:

In some cases, a healthcare provider may recommend supplementing breast milk or formula with additional nutrients, such as vitamin D, to help manage jaundice.

Skin-to-skin contact:

Skin-to-skin contact with the mother or father can help promote bonding and may help regulate the baby’s body temperature and promote weight gain.

Exposure to sunlight:

Doctors can treat mild jaundice with exposure to natural sunlight for a few minutes at a time. However, it is important to consult with a healthcare provider before attempting this, as overexposure to sunlight can be harmful to the baby.

It is important to note that these measures should be used in conjunction with medical treatment and should not be used as a substitute for medical care. If a baby is showing signs of severe jaundice or is not responding to treatment, medical attention should be sought immediately.

How can you prevent newborn jaundice?

In order to prevent neonatal jaundice, it is important for healthcare providers to monitor newborns for signs of the condition and to identify any risk factors that may increase the likelihood of jaundice developing. Breastfeeding can also help to prevent jaundice, as it promotes the elimination of bilirubin from the body. In cases where jaundice is caused by blood type incompatibility between mother and baby, special measures may need to be taken to prevent or manage the condition.

While neonatal jaundice is a common and often mild condition in newborns, it is not always possible to prevent it. However, there are some steps that can be taken to reduce the risk of neonatal jaundice or to detect and treat it early.

Some measures that may help prevent or manage neonatal jaundice include:

Prenatal care:

Regular prenatal care can help identify and manage any conditions that may increase the risk of neonatal jaundice, such as Rh incompatibility or G6PD deficiency.

Early and frequent feeding:

Breastfeeding or formula feeding the baby early and frequently can help promote the excretion of bilirubin in the stool and prevent dehydration.

Phototherapy:

Early treatment with phototherapy can help prevent the progression of neonatal jaundice and reduce the risk of complications.

Follow-up care:

Babies who are at higher risk for neonatal jaundice may need closer follow-up care to ensure that the condition is detected and treated early.

Blood type matching:

For babies who are at risk for Rh incompatibility, blood type matching and the use of Rh immunoglobulin can help prevent the development of neonatal jaundice.

It is important for parents to work closely with their healthcare provider to ensure that their baby receives appropriate care and monitoring for neonatal jaundice. While it may not always be possible to prevent neonatal jaundice, early detection and treatment can help prevent complications and ensure the best possible outcomes for the baby.

Complications of jaundice in newborn babies

In most cases, neonatal jaundice is a mild and self-limited condition that resolves without complications. However, in rare cases, severe or prolonged neonatal jaundice can lead to serious complications, and in very rare cases, it can be fatal.

One of the most serious complications of neonatal jaundice is a condition called kernicterus, which occurs when bilirubin levels become very high and the substance begins to accumulate in the brain. This can lead to brain damage, seizures, hearing loss, and even death.

While kernicterus is very rare, it is a serious concern for healthcare providers and parents. That’s why early detection and treatment of neonatal jaundice are critical to preventing complications and ensuring the best possible outcomes for the baby.

It’s important to note that jaundice is a common and usually harmless condition in newborns, and can be easily treated through medical interventions. However, severe or untreated jaundice can lead to serious complications, so it’s important for premature babies to be closely monitored and treated as needed.

Parents should be aware of the signs and symptoms of neonatal jaundice and seek prompt medical attention if they are concerned about their baby’s health. Healthcare providers can monitor bilirubin levels and provide appropriate treatment to manage neonatal jaundice and prevent complications.

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