Neonatal Jaundice: Causes, Symptoms, Diagnosis, and Treatment

Neonatal Jaundice (Hyperbilirubinemia)

Neonatal jaundice is a condition that is common in newborns, caused by an excess of bilirubin in the blood. The bilirubin is a substance produced by the breakdown of hemoglobin in red blood cells, and it can become dangerously high in newborn babies, causing them to become yellowish in color, known as jaundice. If left untreated, neonatal jaundice can lead to complications such as hearing or vision loss. Fortunately, there are treatments available to lower the bilirubin levels, including phototherapy and exchange transfusions. With proper medical care, most cases of neonatal jaundice can be managed quickly and effectively. Please keep reading for details on the following topics:

Causes of jaundice in newborns

Symptoms of jaundice in newborns

Diagnosis of jaundice in newborns

Treatment for jaundice

Phototherapy

Risks of phototherapy

Phototherapy management

CAUSES OF JAUNDICE IN NEWBORNS

Neonatal jaundice, or jaundice in newborns, can be caused by several factors:

Bilirubin Excess: Jaundice occurs when there’s an accumulation of bilirubin in the baby’s blood. Bilirubin is a yellow pigment produced during the breakdown of red blood cells. Newborns often have higher levels of bilirubin because their livers are still developing, and they may not be able to process bilirubin efficiently.
Infections: Certain infections, such as bacterial or viral infections, can cause jaundice in newborns. These infections can affect the liver’s ability to process bilirubin or lead to increased breakdown of red blood cells, resulting in higher bilirubin levels.
Gastrointestinal Issues: Conditions affecting the gastrointestinal tract, such as obstruction or malabsorption, can disrupt the normal metabolism and excretion of bilirubin, leading to jaundice.
Rh Incompatibility: Rh incompatibility occurs when the mother’s blood type is Rh-negative, and the baby’s blood type is Rh-positive. If the mother’s immune system produces antibodies against the baby’s Rh-positive blood cells, it can lead to the destruction of red blood cells and an increase in bilirubin levels, causing jaundice.

SYMPTOMS OF JAUNDICE IN A NEWBORN

Yellow tint to the skin and eyes: Jaundice typically manifests as a yellowish discoloration of the skin and the whites of the eyes due to elevated levels of bilirubin in the blood.
Poor feeding: Jaundiced newborns may have difficulty with feeding, which can be attributed to lethargy or other symptoms of jaundice.
High-pitched cry: Some jaundiced newborns may exhibit a high-pitched cry, which can be a sign of discomfort or distress.
Lethargy: Jaundice can cause newborns to be unusually sleepy or lethargic, with reduced activity and responsiveness.
Irritability: In some cases, jaundiced newborns may become irritable or fussy, possibly due to discomfort or other symptoms associated with jaundice.

HOW JAUNDICE IS DIAGNOSED IN A NEWBORN

Jaundice in a newborn is typically diagnosed through a combination of methods, including:

Interview and Physical Examination: Healthcare providers will conduct a thorough interview with the parents to gather information about the newborn’s health history and any symptoms observed. A physical examination will also be performed to assess the extent of jaundice and check for other signs of illness.
Blood Test: A blood test is the most accurate way to measure the level of bilirubin in the newborn’s blood. A small sample of blood is usually taken from the baby’s heel or a vein for analysis. This test helps determine the severity of jaundice and identify any underlying conditions causing it.
Skin Test: In some cases, healthcare providers may use a transcutaneous bilirubin meter to measure the level of bilirubin in the baby’s skin non-invasively. This device is placed against the baby’s skin to assess the degree of jaundice.
Transcutaneous Bilirubinometry: This non-invasive method involves using a special device called a transcutaneous bilirubinometer. The device is placed on the baby’s skin, typically on the forehead or chest, and emits light to measure the level of bilirubin in the skin. While this method provides a quick estimate of bilirubin levels, blood tests are still needed for confirmation.

PHYSICAL EXAM

During a physical exam for jaundice in a newborn, healthcare providers will typically:

Assess Skin Color: They will examine the newborn’s skin to determine if there is a yellowish discoloration, which is indicative of jaundice.
Check Eye Color: The whites of the newborn’s eyes will be examined for any yellowing, known as scleral icterus, which is another sign of jaundice.
Evaluate Vital Signs: Vital signs such as temperature, heart rate, and respiratory rate will be checked to assess the newborn’s overall health status.
Palpate the Abdomen: Healthcare providers may gently palpate the abdomen to check for any signs of liver enlargement or abdominal tenderness.
Perform Neurological Assessment: They will assess the newborn’s neurological status, including muscle tone, reflexes, and level of consciousness, to rule out any neurological complications associated with severe jaundice.
A thorough physical examination will be performed to identify any other signs or symptoms that may indicate an underlying cause of jaundice, such as infections or metabolic disorders.

Based on the findings of the physical exam, healthcare providers can determine the severity of jaundice and develop an appropriate management plan, which may include further diagnostic tests or treatment interventions.

BLOOD TEST

A blood test for jaundice involves collecting a small sample of blood from the newborn, typically through a heel stick or from a vein, and analyzing it to measure the level of bilirubin in the bloodstream. This test is the most accurate way to diagnose jaundice and assess its severity. Healthcare providers may use a variety of techniques, such as total serum bilirubin (TSB) or direct bilirubin measurements, to determine the concentration of bilirubin in the blood. Based on the results of the blood test, healthcare providers can develop an appropriate treatment plan to manage the jaundice effectively.

SKIN TEST

A skin test for jaundice involves using a transcutaneous bilirubinometer, a non-invasive device that measures the level of bilirubin in the skin. This test is often performed by placing the device against the baby’s skin, typically on the forehead or sternum, and emitting light to assess the yellow pigment caused by bilirubin. The device then provides a reading of the bilirubin level, helping healthcare providers determine the severity of jaundice without the need for a blood test. This method is particularly useful for screening and monitoring jaundice in newborns, although confirmatory blood tests may still be necessary for a definitive diagnosis.

TREATMENT FOR JAUNDICE

Treatment for jaundice in newborns depends on several factors including the cause and severity of the condition. Common treatments include:

Phototherapy- The use of light to reduce the bilirubin levels in the body
Increased feeding- Ensuring that baby is fed regularly every 2 – 3 hours
Exchange transfusion- Removal of a small amount of blood from the baby and replacing it with a donor’s blood containing normal amount of bilirubin
Intravenous immunoglobulin is administered to infants with rhesus disease; when the mother has rhesus positive blood and the mother had rhesus negative blood
Monitoring and Supportive Care: Regular monitoring of bilirubin levels and overall health status is important. Babies with jaundice may require additional care such as hydration support, temperature regulation, and monitoring for any complications.

EXCHANGE TRANSFUSION

Exchange transfusion is a medical procedure used to treat severe cases of neonatal jaundice that do not respond to other treatments. During an exchange transfusion:

A small amount of the baby’s blood is slowly removed from their body.
The removed blood is replaced with donor blood or a blood product containing normal levels of bilirubin.
This process helps rapidly lower the baby’s bilirubin levels by removing the excess bilirubin-containing blood and replacing it with healthy blood.

Exchange transfusion is typically performed under carefully controlled conditions in a hospital setting by trained healthcare professionals. It may be indicated in cases of severe jaundice where bilirubin levels pose a risk of complications such as brain damage (kernicterus).

While exchange transfusion can effectively lower bilirubin levels, it is considered an invasive procedure and carries risks, including bleeding, infection, and adverse reactions to the donor blood. Therefore, it is usually reserved for cases where other treatments have been ineffective or when the risk of complications from severe jaundice outweighs the risks associated with the procedure.

INTRAVENOUS IMMUNOGLOBULIN

Intravenous immunoglobulin (IVIG) is a treatment option used for certain cases of neonatal jaundice, particularly when jaundice is caused by Rh incompatibility or other immune-related factors. IVIG involves administering a solution containing antibodies derived from healthy donors directly into the baby’s bloodstream via intravenous infusion.

Here’s how IVIG works and its role in treating neonatal jaundice:

IVIG contains antibodies that can help prevent the destruction of red blood cells, which is a common cause of elevated bilirubin levels in newborns. These antibodies target and neutralize the maternal antibodies that may be attacking the baby’s red blood cells, reducing hemolysis (the breakdown of red blood cells) and subsequently lowering bilirubin levels.

Treatment of Rh Incompatibility: In cases where the mother’s blood type is Rh-negative and the baby’s blood type is Rh-positive, the mother’s immune system may produce antibodies against the baby’s Rh-positive red blood cells. This immune response can lead to hemolytic disease of the newborn (HDN), resulting in severe jaundice. IVIG can be administered to the baby to block the action of maternal antibodies and prevent further red blood cell destruction.
Other Immune-Related Causes: IVIG may also be used to treat other immune-related causes of neonatal jaundice, such as ABO incompatibility or autoimmune hemolytic disease.

Administration: IVIG is typically administered as a series of infusions over a period of time, with the dosage and duration determined based on the severity of jaundice and the underlying cause. The infusion is usually given slowly and under close medical supervision to monitor for any adverse reactions.

After IVIG treatment, healthcare providers will monitor the baby’s bilirubin levels and overall condition to assess the effectiveness of the treatment. Additional treatments or interventions may be necessary depending on the baby’s response. While IVIG can be effective in treating certain cases of neonatal jaundice, it is not without risks. Potential side effects of IVIG infusion may include allergic reactions, fever, and fluid overload.

PHOTOTHERAPY

Phototherapy is a common treatment for neonatal jaundice, which involves exposing the baby’s skin to specialized blue or white lights. Here’s how phototherapy works and its role in treating neonatal jaundice:

Bilirubin, the yellow pigment responsible for jaundice, absorbs light energy when exposed to certain wavelengths of light. Phototherapy utilizes specific wavelengths of blue or white light to penetrate the baby’s skin and break down the bilirubin molecules into forms that can be easily excreted from the body through urine and stool.

Types of Phototherapy:

- Conventional Phototherapy: The baby is placed under fluorescent lights, either with naked skin or wearing a diaper and protective eye shields. The light sources are positioned close to the baby to maximize skin exposure.
- Fiberoptic Phototherapy: This method involves using fiberoptic blankets or pads that emit light directly onto the baby’s skin. Fiberoptic devices are flexible and can be wrapped around the baby’s body, providing uniform exposure to light.

Phototherapy is typically administered in a hospital setting, either in the nursery or neonatal intensive care unit (NICU). The duration and intensity of phototherapy depend on the baby’s bilirubin levels and overall health status.

RISKS OF PHOTOTHERAPY

Phototherapy is considered safe when administered properly, although there are potential risks, such as skin rash, dehydration, and eye damage if the baby’s eyes are not adequately protected. However, the benefits of phototherapy generally outweigh the risks, especially when jaundice is severe or poses a risk of complications. These are potential risks or side effects associated with phototherapy treatment for neonatal jaundice:

Skin rash: Some babies may develop a mild rash or irritation on their skin as a reaction to the phototherapy lights. This is usually temporary and resolves once phototherapy is discontinued.
Damage to the retina due to exposure of the eyes to the light: Without proper eye protection, prolonged exposure to phototherapy lights can potentially damage the retina of the baby’s eyes. This is why special eye shields are used to protect the baby’s eyes during treatment.
Dehydration due to inadequate intake of fluid or feeding: Phototherapy can increase fluid loss through the skin, leading to dehydration if the baby does not receive adequate fluids through feeding. It’s important to monitor the baby’s hydration status and ensure they are receiving sufficient fluids during phototherapy.
Poor thermoregulation: Babies undergoing phototherapy may be at risk of poor thermoregulation, especially if they are undressed during treatment. It’s essential to monitor the baby’s body temperature and provide appropriate warmth to prevent overheating or hypothermia.
Overheating: Exposure to phototherapy lights can increase the baby’s body temperature, potentially leading to overheating if not adequately monitored. Careful temperature regulation is necessary to prevent this complication.
Diarrhea: Some babies may experience gastrointestinal upset, including diarrhea, during phototherapy treatment. This can be a result of factors such as changes in feeding patterns or fluid intake.
Skin discoloration: In rare cases, prolonged exposure to phototherapy lights may cause temporary skin discoloration or changes in pigmentation. This typically resolves once phototherapy is discontinued.
Blistering: Severe skin reactions, including blistering or burns, are rare but possible side effects of phototherapy treatment. Proper positioning of the baby and regular monitoring can help prevent such complications.

CARES PROVIDED DURING THE PHOTOTHERAPY SESSION

Healthcare providers monitor the baby’s bilirubin levels regularly during phototherapy to assess the effectiveness of treatment. Babies receiving phototherapy are monitored closely for signs of dehydration, overheating, and other complications. Here are the key aspects of care provided during phototherapy:

Monitoring Nutritional Status: Healthcare providers monitor the baby’s weight and assess feeding patterns to ensure adequate intake of breast milk or formula. Regular feeding intervals, typically every 2 to 3 hours, are maintained to prevent dehydration and promote bilirubin elimination.
Assessment of Urine Output: Healthcare providers monitor the baby’s urine output to assess hydration status. Adequate urine output indicates sufficient fluid intake, while decreased urine output may indicate dehydration, which requires prompt intervention.
Temperature Regulation: The baby’s body temperature is closely monitored to prevent overheating or hypothermia. Thermal regulation may involve adjusting the room temperature, ensuring appropriate clothing, and using temperature-monitoring devices.
Skin Color Evaluation: Healthcare providers regularly assess the baby’s skin color to monitor the effectiveness of phototherapy in reducing jaundice. Improvements in skin color indicate successful treatment, while persistent or worsening jaundice may necessitate adjustments to phototherapy.
Monitoring for Complications: Healthcare providers vigilantly observe the baby for signs of complications associated with phototherapy, such as skin rash, dehydration, or overheating. Any adverse reactions or changes in the baby’s condition are promptly addressed.
Eye Protection: Special eye shields are placed over the baby’s eyes to protect them from the bright phototherapy lights. Eye shields are periodically checked to ensure proper placement and comfort.
Hygiene and Comfort: Healthcare providers ensure the baby’s cleanliness and comfort throughout the phototherapy session. Diapers are changed regularly, and the baby’s skin is assessed for any signs of irritation or discomfort.
Feeding Support: Healthcare providers offer guidance and support to parents regarding breastfeeding or formula feeding techniques during phototherapy. Adequate nutrition is essential for the baby’s growth and recovery.
Bilirubin Level Monitoring: Bilirubin levels are monitored regularly to assess the effectiveness of phototherapy in reducing jaundice. Blood tests may be performed at specified intervals to track bilirubin levels and adjust treatment as needed. Once the bilirubin levels decrease to a safe range, phototherapy may be discontinued.
Parental Education: Parents are provided with information about phototherapy, including its purpose, procedure, and potential side effects. They are encouraged to ask questions and actively participate in their baby’s care.

BILIRUBIN

Bilirubin is a yellowish pigment produced during the normal breakdown of red blood cells in the body, a process known as hemolysis. It is primarily formed in the liver and normally found in the bile as a result of the breakdown of heme, the iron-containing component of hemoglobin found in red blood cells. Bilirubin is transported in the bloodstream to the liver, where it undergoes further processing before being excreted from the body. Elevated bilirubin levels can be an indicator of certain diseases and conditions, including liver and gallbladder issues. Therefore, it is important to monitor bilirubin levels in order to ensure good health.

Here are some key points about bilirubin:

Excretion: Bilirubin is excreted from the body through bile, a digestive fluid produced by the liver. It is eventually eliminated from the body in feces and a small portion through urine.
Coloration: Bilirubin is responsible for the yellow color of bile, as well as the yellowish discoloration of the skin and eyes observed in jaundice when bilirubin levels are elevated.
Measurement: Bilirubin levels in the blood can be measured through blood tests. Total serum bilirubin (TSB) measures the combined levels of unconjugated (indirect) and conjugated (direct) bilirubin, while fractionated bilirubin tests separately measure unconjugated and conjugated bilirubin.
Conjugation: Unconjugated bilirubin is insoluble in water and must be conjugated (modified) in the liver to become water-soluble and excretable. Conjugation involves the addition of glucuronic acid to bilirubin, converting it into a soluble form known as conjugated bilirubin or direct bilirubin.
Transport: Bilirubin is transported in the bloodstream bound to albumin, a protein produced by the liver. Unconjugated bilirubin is less tightly bound to albumin than conjugated bilirubin.
Role in Disease: Elevated levels of bilirubin in the blood can indicate liver or gallbladder dysfunction, hemolytic disorders (excessive breakdown of red blood cells), or other medical conditions. Jaundice, characterized by yellowing of the skin and eyes, is a common symptom of elevated bilirubin levels.

Bilirubin test

The bilirubin test is a medical test used to measure the amount of bilirubin in the blood. Bilirubin is a yellow pigment that is produced by the normal breakdown of red blood cells. If the level of bilirubin is too high, it can indicate a liver or gallbladder problem. The bilirubin test is typically used to diagnose jaundice, and other conditions that affect the liver, gallbladder, and bile ducts. The test results can also be used to monitor the effectiveness of certain treatments.

Procedure: In most cases, no special preparation is required for a bilirubin test. The test involves collecting a small sample of blood from a vein, usually from the arm. In infants, blood may be obtained through a heel stick. The blood sample is then sent to a laboratory for analysis.

Types of Bilirubin: There are three main types of bilirubin measured in the blood:

- Total bilirubin: This includes both indirect (unconjugated) and direct (conjugated) bilirubin.
- Direct bilirubin: Also known as conjugated bilirubin, it is the water-soluble form of bilirubin that has been processed by the liver and is ready for excretion.
- Indirect bilirubin: Also known as unconjugated bilirubin, it is the insoluble form of bilirubin that has not yet been processed by the liver.

Interpretation: Elevated levels of bilirubin in the blood may indicate liver dysfunction, bile duct obstruction, hemolytic anemia, or other medical conditions. The interpretation of bilirubin levels depends on various factors, including the patient’s age, medical history, and symptoms. The normal range for total bilirubin levels in adults is typically between 0.3 to 1.2 milligrams per deciliter (mg/dL). However, reference ranges may vary slightly between laboratories.

Disclaimer: The information provided in this content is for general informational purposes only. It is not intended as medical or healthcare advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or healthcare decisions.