Introduction
Bringing a newborn home is an exciting but overwhelming experience. Amidst the joy, it is important to be aware of certain health conditions that can affect newborns. A common condition is jaundice, also known as hyperbilirubinemia. This blog will help you understand what jaundice is, its causes, symptoms, treatment, and when to consult a doctor.
What is Jaundice?
Jaundice is a condition in which a newborn’s skin and the whites of their eyes turn yellow. This yellowness is caused by high levels of bilirubin in the blood. Bilirubin is a yellow pigment produced during the normal breakdown of red blood cells. The liver processes bilirubin, but in newborns, especially those born prematurely, the liver may not be fully developed to handle it efficiently.
Causes of Jaundice In Newborn
Jaundice in newborns can occur for several reasons:
- Physiological jaundice: This is the most common type and usually appears between the second and fourth day of life. It is a natural response as the baby’s body adapts to process bilirubin outside the womb.
- Breastfeeding jaundice: Occurs in breastfed infants due to inadequate breast milk intake in the first week of life, leading to dehydration and reduced bilirubin excretion.
- Breastfeeding jaundice: Develops after the first week and is thought to be associated with substances present in breast milk that increase the reabsorption of bilirubin in the intestines.
- Hemolytic jaundice: Occurs due to blood type incompatibility between mother and baby, leading to rapid breakdown of red blood cells.
- Premature babies have an underdeveloped liver, making it harder to process bilirubin.
Symptoms of Jaundice
- Yellowing of the skin and eyes, starting in the face and progressing downward.
- Poor feeding or lethargy.
- Dark, yellow urine (should be colorless in newborns).
- Light-colored stools (should be yellow or orange in breastfed babies).
Diagnosing Jaundice
If jaundice is suspected, the healthcare provider will:
- Physical exam: Check the baby’s skin and eyes for yellowing.
- Bilirubin test: Measure the level of bilirubin in the baby’s blood. This can be done through a skin test or a blood test.
Jaundice Levels In Newborn – Bilirubin Levels and Their Implications
Bilirubin levels are typically classified into different ranges, each indicating a varying degree of jaundice severity and corresponding management strategies.
- Normal Levels
- 0 to 1 mg/dL: Normal range for adults and older children.
- 1 to 5 mg/dL: Considered normal for newborns within the first few days of life as they adjust to extrauterine life.
- Mild Jaundice
- 5 to 12 mg/dL: Common in many newborns. Usually, it requires monitoring and ensuring proper feeding. This level often resolves on its own without treatment.
- Moderate Jaundice
- 12 to 20 mg/dL: Requires closer monitoring and may necessitate treatment such as phototherapy, especially if levels are rising quickly or the baby is premature.
- Severe Jaundice
- Above 20 mg/dL: This level is concerning and usually requires prompt intervention. Intensive phototherapy or even exchange transfusion may be needed to prevent complications.
- Critical Jaundice
- Above 25 mg/dL: This is an emergency. High bilirubin levels can lead to a condition called kernicterus, a form of brain damage. Immediate treatment is essential to prevent long-term damage.
Treatment options
Treatment for jaundice depends on its severity:
- Phototherapy: The baby is placed under special blue lights that help break down bilirubin in the skin.
- Exchange transfusion: In severe cases, the baby’s blood is replaced with fresh blood to rapidly reduce bilirubin levels.
- Feeding assistance: Increasing the frequency of feedings may help reduce bilirubin levels by promoting regular bowel movements.
Signs of recovery from jaundice in newborns
1. Less yellowing of the skin and eyes
One of the most noticeable signs of recovery from jaundice is less yellowing of the skin and the whites of the eyes (sclera). The yellow color usually fades first from the face and then gradually disappears from the body and limbs.
2. Improved feeding and weight gain
- Feeding: A baby recovering from jaundice will often show more interest in feedings. They will latch on more effectively and drink milk more often, whether breastfeeding or bottle feeding.
- Weight gain: Consistent weight gain is a positive sign of recovery. A newborn who is feeding well will gain weight appropriately, which helps reduce bilirubin levels through regular bowel movements.
3. Regular bowel movements
Frequent and regular bowel movements are a good sign that the baby’s body is flushing out bilirubin effectively. The colour of stool in breastfed babies should change from dark and sticky meconium to a yellow or mustard colour. Formula-fed babies may have a slightly different colour of stool, but the main thing is regularity and frequency.
4. Normal urine colour
As jaundice resolves, the colour of the baby’s urine should lighten. Dark urine can be a sign of increased bilirubin levels, so a return to light-coloured urine is a positive indicator of recovery.
5. Increased alertness and activity
Babies recovering from jaundice often become more alert and active. They will stay awake for longer periods of time and show interest in their surroundings. Improved muscle tone and more vigorous movements are also good signs.
6. Stable bilirubin levels
- Monitoring: Regular monitoring of bilirubin levels by healthcare providers will show a steady decrease in bilirubin concentrations. This is often confirmed through blood tests or transcutaneous bilirubinometry.
- Trend: A decline in bilirubin levels over several days is a strong indicator that the baby is recovering from jaundice.
7. Absence of complications
Recovery from jaundice is also indicated by the absence of complications such as kernicterus (a form of brain damage caused by very high bilirubin levels). If the baby shows no signs of neurological problems such as abnormal muscle tone, arching of the back or high-pitched crying, it is a good sign of recovery.
When to seek medical help
Although mild jaundice is often harmless and resolves on its own, it’s important to contact a healthcare provider if:
- The baby appears very pale or the paleness spreads beyond the face.
- The baby is not feeding well or is very lethargic.
- There are signs of dehydration, such as fewer wet diapers.
- The baby’s urine is dark or the stool is pale.
Conclusion
Jaundice is a common condition in newborns, and understanding its causes, symptoms, and treatments can help parents manage it effectively. While most cases are mild and resolve without any intervention, being informed and vigilant ensures that your baby gets the best possible care. If you have any concerns about your newborn’s health, always consult your pediatrician.