Neonatal Jaundice

Neonatal jaundice is a condition that occurs when too much bilirubin builds up in a new baby’s body, causing a yellowing of the skin and whites of the eyes.

Other Names

 * Neonatal hyperbilirubinemia

Types

 * Physiological: this occurs naturally in some newborns around the second day after birth and resolves spontaneously without treatment after approximately a week (a little longer in premature babies.
 * Non-Physiological: is pathological and usually appears at day one after birth and does not resolve without treatment.

Signs and Symptoms
Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. The baby’s doctor or nurse can test how much bilirubin is in the baby’s blood.

Kernicterus
Seek medical attention if the baby:


 * Is very yellow or orange (skin color changes start from the head and spread to the toes)
 * Is hard to wake up or will not sleep at all
 * Is not breastfeeding or sucking from a bottle well
 * Is very fussy
 * Does not have at least 4 wet or dirty diapers in 24 hours

Causes
Jaundice can develop when red blood cells (RBCs) break down leading to an increase in bilirubin in the bloodstream. RBCs have a life span so it is normal for some red blood cells to die each day. In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin.

Risk factors
Babies with any of the following risk factors need close monitoring and early jaundice management:


 * A baby with a brother or sister that had jaundice is more likely to develop jaundice.


 * A baby who is not eating, wetting, or stooling well in the first few days of life is more likely to get jaundice.


 * A baby who has bruises at birth is more likely to have jaundice. A bruise forms when blood leaks out of a blood vessel and causes the skin to look black and blue. Then, when the bruise begins to heal, red blood cells die. Bilirubin is made when red blood cells break down. The healing of large bruises may cause high levels of bilirubin, and the baby may become jaundiced.


 * A baby who is yellow in the first 24 hours of life may get dangerously jaundiced.


 * A baby born to an East-Asian or Mediterranean family is at a higher risk of becoming very jaundiced. Also, jaundice is harder to see in babies with darker skin tones. Some families inherit conditions (such as G6PD), and their babies are more likely to become jaundiced.


 * Babies born before 37 weeks, or 8 ½ months, of pregnancy may become jaundiced because their liver may not be fully developed. The young liver may not be able to get rid of so much bilirubin. If too many red blood cells break down at the same time, the baby can become very yellow or may even look orange.


 * Women with an O blood type or Rh negative blood factor might have babies with higher bilirubin levels. A mother with Rh incompatibility should be given Rhogam.

Clinical Trials
Clinical trials recruiting: from ClinicalTrials.gov

Recovery time
When severe jaundice goes untreated for too long, it can cause brain damage and a condition called kernicterus. Kernicterus is a type of brain damage that causes athetoid cerebral palsy and hearing loss. It also causes problems with vision and teeth and sometimes can cause mental retardation.

Any baby with untreated jaundice is at risk for kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion.

Prevention
No baby should develop brain damage from untreated jaundice. If a baby gets too jaundiced, the baby can be treated with phototherapy. That is, the baby can be put under blue lights most of the day. The blue lights do not bother the baby. They are warm and probably feel good. If the baby gets very, very jaundiced, the doctor can do an exchange transfusion. <

Incidence
About 60% of all babies have jaundice. Some babies are more likely to have severe jaundice and higher bilirubin levels than others.

Other Resources
Parents of Infants and Children of Kernicterus

 Question and Answers: Jaundice and the Newborn Baby