Neonatal Jaundice Causes Symptoms Treatment Edokita Health Online Medical Consultation in Nigeria

Neonatal jaundice is yellowish discolouration of the sclera of the eye, skin and other mucous membranes in the body in the first 28 days of the life of a child. You may also detect neonatal jaundice by blanching the skin of the baby. Neonatal jaundice may also lead to irreversible brain damage. The incidence of neonatal jaundice is higher in East Asians and American Indians and lower in Africans. However, the mortality rate associated with neonatal jaundice is higher in Africans due to late presentation and poor healthcare infrastructure.

Causes of Neonatal Jaundice   

Neonatal jaundice results when there is a rise in the level of unconjugated bilirubin {>30 µmol/L (1.8 mg/dL)} during the first week of life. The causes of neonatal jaundice can be physiological or pathological.

  • Physiologic jaundice presents on the second or third day of the life of the child and usually resolves on the fifth to seventh day for term infant and 10-14th day for the preterm infant. It results due to the breakdown of fetal haemoglobin as it is replaced with adult haemoglobin and the relatively immature metabolic pathways of the liver, which are unable to conjugate and excrete bilirubin as quickly as an adult. There is usually no associated symptom and the child feeds well. It resolves on its own.

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  • Pathologic jaundice; this can be present from the first day of life. It is due to an underlying condition in the child. Example of such conditions includes;
    • Neonatal sepsis; is the presence of a bacterial bloodstream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in a newborn baby with an associated fever.
    • Blood group incompatibility; this results when the mother’s blood cells develop antibodies that can attack the newborn’s blood cells such as in ABO incompatibility, rhesus incompatibility
    • Prematurity; these are babies born at less than 37 weeks. The risk of significant neonatal jaundice is inversely proportional to gestational age (the lower the numbers of weeks at birth the higher the chances of having jaundice)
    • Abnormalities in red blood cells; such as sickle cell disease, spherocytosis, Glucose 6 phosphate deficiency, hereditary elliptocytosis.
    • Breast milk jaundice; develops in a breastfed infant after the first 4-7 days of life, persists longer than physiologic jaundice, and has no other identifiable cause.
    • Hypothyroidism; there is the insufficient production of thyroid hormone which is needed for normal body metabolism. There is, therefore, delay in excretion of bilirubin from the intestine.
    • Bowel obstruction; bilirubin is excreted via faeces. Any obstruction in the bowel movement will result in jaundice.
    • Polycythemia; this is excessive red blood cell in the body. The body tries to break down these cells and this leads to an increase in bilirubin production.
    • Intrahepatic or extrahepatic duct obstruction; as seen in biliary atresia, there is an obstruction in the excretion of bilirubin resulting in its accumulation in the body.

 

Symptoms of Neonatal Jaundice

The major symptom of neonatal jaundice is yellowness of the sclera (white part) of the eye. There is a yellowness of other mucous membrane and even the skin of the child.

Other associated symptoms depend on the underlying cause and they include;

  • Fever
  • Refusal of feed
  • Vomiting
  • Diarrhea
  • Pallor
  • Failure to thrive
  • Reduced activity

 

Treatment of Neonatal Jaundice

  • Physiologic jaundice; this usually resolves on its own, however, it is important to still take your child to see the doctor who will access the child. The doctor accesses the level of the bilirubin in the blood. If it is on the high side, the child is exposed to phototherapy or to the early morning sun.
  • Pathologic jaundice; this involves detecting and treating the underlying cause of jaundice. This has to be promptly done so as to avoid the irreversible brain damage caused by jaundice.

Ways of treating neonatal jaundice include;

  • Phototherapy; this uses a type of colour light, which works at a specific frequency of blue light to change trans-bilirubin into the water-soluble cis-bilirubin isomer so the body can easily excrete it. The light can be applied with overhead lamps, which means that the baby’s eyes need to be covered, or with a device called a Biliblanket, which sits under the baby’s clothing close to its skin
  • Exchange blood transfusion; doctors replace some of the baby’s blood with fresh red blood cells. This is done to reduce the level of bilirubin in the blood.

 

Neonatal jaundice shouldn’t result in any complication if patients promptly and properly manage it. Brain damage due to kernicterus remains a true risk. The apparent increase in the incidences of kernicterus in recent years may be due to the misconception that jaundice in the healthy full-term infant is not dangerous.