Hematology
Infant Jaundice

Summary:

  • It is a condition caused by a buildup of bilirubin in the blood, which leads to a yellow tinge to the skin and whites of the eyes in newborns. 
  • It is caused by incomplete growth of the liver, which makes it unable to get rid of the bile.
  • Infant jaundice often goes away within two weeks without any treatment, and only requires follow-up.
  • Neglecting proper treatment in advanced cases could cause the infant to develop brain problems.
  • Regular breastfeeding (8 to 12 times a day) during the first few days in an infant’s life is one of the most important ways of prevention.

Overview:
Infant jaundice is a common condition, - particularly in babies born before 38 weeks' gestation (preterm babies)-  caused by the buildup of bilirubin in the bloodstream which is a yellow pigment formed by the breakdown of used red blood cells to be replaced by new red blood cells. Bilirubin is filtered in the liver and then it is expelled with the stool.

Other names:
Newborn jaundice, ‎Icterus, hyperbilirubinemia

Cause:
Physiological jaundice:
While the fetus is in the womb, the placenta removes the yellow substance (bilirubin) from the body, and after birth, the liver takes over this function. The underdeveloped liver of newborns is not fully functioning yet to efficiently filter bilirubin from the bloodstream resulting in its accumulation. Most babies between two and four days old are naturally yellowish in color, and the amount of the yellow substance in the body does not exceed 200 micromole/liter. This yellowing often disappears within two weeks.

Pathological jaundice:
  1. Neonatal jaundice:  It appears in the first 24 hours of the newborn's life, and is caused by:
    • The breakdown of blood cells (e.g. incompatibility between the mother's blood type and the baby's).
    • Infection: Before delivery: (e.g. toxoplasmosis, German measles (rubella) and syphilis), after birth.
    • Crigler–Najjar syndrome
  2. Prolonged neonatal jaundice: It lasts for more than two weeks, and more than 21 days in preterm infants, and it is caused by:
    • Infection (e.g. urinary tract infection);
    • Hypothyroidism
    • Disorders in the digestive system (e.g. bile duct problems, and neonatal hepatitis).

Symptoms:
The first sign of infant jaundice is yellow skin and eyes the second day after birth.

When to see a doctor?
The infant will be examined within 72 hours of delivery to confirm jaundice, and the doctor must be consulted immediately if the symptoms develop in any of the following ways:
  • If the infant's skin becomes more yellowish;
  • If the infant is difficult to awaken;
  • If the infant doesn’t gain weight;
  • If the infant makes high-pitched cries;
  • If the infant is feeding poorly or refusing feedings;
  • If jaundice lasts more than two weeks.
Diagnosis:
  • Clinical examination
  • Laboratory tests: Measuring levels of bilirubin in the blood, and any other necessary tests.

Risk factors:
  • Family history of jaundice
  • Family history of blood diseases
  • Infant malnutrition during the first days of life
  • Premature birth (preterm birth)
  • Low birth weight
  • Bruising during delivery
  • Incompatibility of the mother's blood group with the baby’s
  • iabetic mothers

Complications:
When the jaundice lasts more than three weeks, the infant may suffer from the following complications:
  • Hearing loss;
  • Cerebral palsy and other forms of brain damage.

Treatment:
  • Infant jaundice often disappears within two weeks without any treatment, only requiring some observation. Treatment is usually recommended only if tests show that the infant has very high levels of bilirubin in the blood (more than 200 micromole/ liter). There are two main treatments that can be administered at the hospital:
  • Light therapy (phototherapy) The light breaks down the structure of bilirubin molecules so they can be excreted.
  • In extreme cases the infant may need an exchange transfusion.

Prevention:
Infants should be breastfed 8 to 12 times a day for the first several days of life.
It is important not to miss any medical appointments after birth.
The newborn must be closely observed during the first 5 days after birth.

FAQs:
  • Does exposing a baby with jaundice to sunlight act as a substitute for other treatments?
    • Jaundice is treated by exposure to sunlight only when the case is mild. Advanced cases require light therapy. 
  • Is it advisable to stop breastfeeding a baby to treat their jaundice?
    • Mothers are advised against stopping breastfeeding because of its importance and usefulness for the infant.
  • Can a baby be treated at home by exposure to bright light?
    • Keeping the baby under bright light at home will not cure jaundice. In fact, it may cause other problems (e.g. fever or chills) due to unnecessary light exposure. Moreover, you should avoid giving your baby herbal or home remedies without asking their pediatrician first.

Myths & Truths:

  • Jaundice can be treated with honey or sugar.
    • Honey and sugar cannot cure a baby’s jaundice. In fact, they may cause the baby health problems during their first year. Mothers should avoid eating yellow foods when breastfeeding.
  • No scientific evidence suggests that eating yellow foods (vegetables, fruits or drinks) can cause jaundice.
    • Jaundice means that a breastfed infant is not adapting to the mom's breast milk, so they should be given water instead of milk. Mothers’ milk is the best food for babies. Refrain from giving water to your infant. 

 
Health Promotion and Clinical Education General Department
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Last Update : 07 March 2021 05:28 AM
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