Jaundice in Newborn Babies – Types, Causes, Symptoms and Treatment by Dr Lathiesh Kumar Kambham

The baby’s liver – the organ that breaks down bilirubin – is not yet completely developed in the initial days of the birth of a newborn baby. This is why it is common for a baby’s bilirubin level to spike after birth (when he/she was inside you, your placenta did the job for it).

How Common is Jaundice in Newborn Babies?

Neonatal jaundice or Jaundice in newborn babies is a common disease. It occurs due to the failure of the liver to break down the bilirubin levels. The increased amount of Total Serum Bilirubin (TSB) causes this condition.

Neonatal jaundice is common and occurs both in full-term and preterm babies. It normally reduces without the need for treatment. In rare cases, the occurrence can be severe and demand immediate care.

After birth, a regular checkup is necessary for jaundice in neonates. Doctors may check once every 12 hours for as long as they are in the hospital. Its severity is identified by looking at the baby’s body color in bright light. A regular follow-up according to the prescribed timing is vital to keep track of your baby’s health condition.

Causes of Jaundice in Infants

Jaundice occurs due to an anomaly in the functioning of the liver. While the exact causes of jaundice in infants is difficult to pinpoint, here are a few contributing factors.

• Incompatible blood groups of the mother and the baby can lead to jaundice in newborns.
• Rapid breakdown of red blood cells (hemolytic anemia) is an autoimmune disease that increases the levels of bilirubin, leading to jaundice in newborns.
• Increased back and forth movement of bile acids and bilirubin due to the lack of proper breastfeeding can also lead to jaundice in newborns.
• Improper liver enzyme functioning can lead to jaundice in newborns.
• Bruising or internal bleeding during birth may cause hemolysis or rapid red blood cell breakdown, which leads to an increased level of Bilirubin in infants.

Signs and Symptoms of Jaundice in Newborn Babies

Symptoms of jaundice in newborns include

• Yellowing of the skin, especially palm, sole, and eyes
• A high-pitched crying is an indication of severe jaundice that requires immediate attention
• Dark yellow-colored urine
• Pale or clay-colored poop. This indicates the excess amount of bilirubin in the body.
• Poor appetite
• Lack of energy and lethargy

Types of Jaundice in NewBorn Babies

Some of the common types of jaundice in newborns include:

1. Breastfeeding Jaundice

This occurs when babies do not get enough breast milk – either because they have difficulty taking in milk or because the mother’s milk hasn’t come down yet. This causes the concentration of bilirubin in the blood to rise. It starts after 48-72 hours and usually subsides when your baby starts getting enough milk.

[Read : Low Milk Supply – Breastfeeding Issues]

2. Pathological Jaundice

Pathological jaundice is diagnosed by measuring the range of TSB levels. A number that disagrees with the levels of TSB in physiological jaundice falls under pathological jaundice. Infants with pathological jaundice are diagnosed with jaundice within 24 hours of birth. An abnormal rise in TSB levels, greater than 5 mg/dl per day indicates pathological jaundice. An increased level of Total Serum Bilirubin of more than 17 mg/dl is considered pathological jaundice.

3. Physiological Jaundice

This is the most common type of jaundice and occurs because the babies’ organs are still maturing and can’t get rid of excess bilirubin efficiently. The clinical assessment for the cause of physiological jaundice is the increase in the levels of TSB (Total Serum Bilirubin) levels. It peaks between 24-72 hours of birth and then falls. The TSB levels are around 12-15 mg/dl for infants with physiological jaundice. The incapability of the liver to break down bilirubin causes physiological jaundice in newborns.

4. Breast Milk Jaundice

This occurs when certain substances in the breast milk interfere with the baby’s liver functionality, resulting in a rise in bilirubin levels. This is a rare condition– only 1-2% of babies get it. Your infant is vulnerable to breast-milk jaundice after the first 3 to 5 days. This condition gradually improves over 3 to 12 weeks.

5. Incompatibility Jaundice

Blood type incompatibility between the mother and the baby results in what is called Blood group incompatibility jaundice. Essentially, it translates into a condition when an infant’s red blood cells get destroyed by some antibodies produced by the mother’s body, increasing the bilirubin level rapidly. This starts within the first 24 hours of the baby’s life. However, in order to prevent this, the mother is given Rh immune globulin injections.

These are the most commonly seen jaundices in healthy newborn babies. If the baby is born prematurely, it is always assumed that their bodies are not mature enough to excrete bilirubin and hence given treatment.

As is evident from the section above, in many cases jaundice peaks after 3 days – when you are most likely home after being discharged from the hospital. Hence it is important to understand different symptoms in your baby.

Diagnosis of Jaundice in Newborn Babies

In most cases, neonatal jaundice can be identified by visual assessments. The doctors may check and observe the baby’s skin in bright light without any yellow background. Yellowing of the eyes is a clear symptom that indicates jaundice in babies.

Doctors may further conduct a test called TcB to measure Total Serum Bilirubin levels to diagnose jaundice in babies. Transcutaneous Bilirubinometry (TcB) is a test that helps measure the TSB levels in babies.

However, TSB measurement can only be done for full-term babies and after 24 hours of birth. Premature babies are not eligible for the TSB measurement test. In most cases, visual assessment of jaundice is reliable.

Treatment Options For Neonatal Jaundice

Since neonatal jaundice is common in infants, mild jaundice does not require any treatment. Generally, the bilirubin levels fall back to normal within a few weeks without requiring any treatment for physiological jaundice.

Your baby’s pediatrician will examine your baby for jaundice before discharge. Even if your baby’s bilirubin level was normal, your doctor would suggest a follow-up visit on the baby’s fifth day of life. Make sure to ask your doctor about follow-up checkups.

Treatment is not needed most of the time. But when it is needed, the type of treatment will depend on:

• The baby’s bilirubin level.
• How fast the level has been rising?
• How old is the baby is?

The treatment options for jaundice include phototherapy and exchange transfusion in severe cases.

1. Phototherapy

Phototherapy is a procedure where the infant is placed under a unit that contains greenish-blue lights. Compact fluorescent lamps are used to carry out phototherapy for full-term babies. In this procedure, a particular wavelength of light breaks down the bilirubin and can be sent out through urine feces.

Phototherapy is an effective and harmless treatment for neonatal jaundice. The tenure of the treatment depends on the severity of jaundice. Doctors take utmost care before placing the baby into an incubator that provides phototherapy treatment. They will protect the eyes and genitals of the baby before proceeding with the treatment.

2. Hydration

For both physiological jaundice and breastfeeding jaundice, what you can do on your own is to ensure your baby is always well-hydrated, either with breast milk or with formula, so he/she will pass urine and stool more often. For breast milk jaundice, the doctor might recommend you not to breastfeed the baby for a couple of days to bring the bilirubin level down.

3. Exchange Transfusion

Exchange transfusion is required for infants’ bilirubin levels affect the brain (bilirubin encephalopathy) leading to abnormalities. In such cases, the total serum bilirubin levels cannot be considered as an indication to decide the level of jaundice. There are different types of exchange transfusions for various conditions causing jaundice in infants. Infants with severe dehydration and weight loss due to jaundice are given IV to promote proper hydration.

You can also check for jaundice at home. Place the baby in a naturally well-lit room and check for yellowish skin. Even if you cannot spot any right away, try pressing the skin on different parts of the baby’s face and look for a yellowish tint as you lift your finger. Also, check for yellowness in the gums or the whites of the baby’s eyes.

Treatment For Jaundice in Newborn Babies at Home

There is no particular treatment for jaundice at home. Physiological jaundice can be treated by proper hydration and breastfeeding, by which the liver will be able to break down the bilirubin properly. There is no proper evidence to consider sun exposure as a treatment for jaundice, and the direct exposure of a baby to the sun may also lead to sunburn. Helping the baby gain proper nutrition through breast or formula milk may reduce the risk of jaundice.

[Read : Sunlight For Babies]

How Can Jaundice in Newborn Babies Be Prevented?

There are no particular measures that can prevent neonatal jaundice. According to the cause, doctors may administer treatments that can work towards eliminating the disease more effectively. However, no evidence proves breastmilk jaundice prevention by pausing breastfeeding or switching to formula. Breastfeeding has many benefits that outweigh the minor possibilities of infants catching breast milk jaundice.

Mild jaundice generally regresses once the liver matures and eliminates bilirubin from the body. Persistent jaundice and pathological jaundice require proper assessments before the treatment. Phototherapy and exchange transfusion are the two major treatments that successfully work to eliminate jaundice in infants. Check baby’s bilirubin levels, and schedule regular follow-ups to prevent jaundice.

When Should You Consider Seeing a Doctor?

Consider calling your doctor if you observe

• Your baby is not gaining weight
• Lethargic and drowsy
• Does not feed well
• High pitched crying
• Visible deep yellowing of the body
• Improper behavior like being fussy and irritable

Jaundice in newborn babies is generally not dangerous in babies who were born full-term and who do not have other medical problems. However, if the bilirubin levels get too high, jaundice can lead to more severe and serious complications like damage to the brain and nervous system or a condition called kernicterus, which can result in deafness or delayed development.

Call your doctor if your baby’s skin continues to become more yellow with time or if your jaundiced baby seems listless or sick or is difficult to awaken. In addition, if your baby’s mild case of jaundice lasts more than three weeks, again consult the pediatrician.

[Read : Vitamin D For Babies]

FAQ’s

1. How Long Does Jaundice Take to go Away in Babies?

Jaundice usually regresses within 2 to 3 weeks of birth. Prolonged jaundice or other severe symptoms of jaundice should be reported to the doctor.

2. What Time of Daylight is Good For Jaundice?

Tender rays of the morning or evening sun are said to treat mild jaundice in babies. However, it is not proven, and exposing babies to direct sunlight may lead to sunburns.

3. Do Vitamin D Drops Help With Jaundice?

Jaundice in newborns is not associated with low vitamin D levels. However, the phototherapy treatment administered for jaundice is without UV rays (which produce vitamin D).

Read Also: Neonatal Screening Tests In India