Newborn jaundice, common in infants, is a condition in which the skin and the white of the eyes turn yellow. However, it is different from the jaundice that affects adults, as both of them have very different causes and treatments. “Almost 80 per cent of babies born prematurely, and more than 60 per cent of term babies get jaundice. Of these, 10 per cent need ‘phototherapy’ which is a form of treatment with special lights,” said Dr Shashidhar Vishwanath, lead consultant in neonatology and paediatrics, SPARSH Hospital for Women and Children.

The majority of jaundice in the newborn period is physiological, which means that it is a part of the normal body process. It is further divided into pathological jaundice, or severe neonatal jaundice.

What causes jaundice?

Bilirubin, the jaundice pigment, is derived from the breakdown of red blood cells. All babies are born with more red blood cells as compared to adults. These red blood cells are broken down after birth, leading to the accumulation of bilirubin in the blood. The liver processes this bilirubin and turns it into a non-toxic form that is removed from the body through urine and stool. However, if this pigment accumulates beyond a certain level, it can cause problems, Dr Vishwanath said.

The most severe is a condition called ‘kernicterus’ when the pigment spreads to the brain and causes various effects. Severe jaundice can cause the baby to become tired, sleepy, lethargic, and refuse feed which can lead to dehydration. In severe cases, they can have altered posture, seizures, and become moribund. “This condition, fortunately, is no longer very common due to improved newborn care and administration of vitamin K,” said Dr Vishwanath.

Breastfeeding failure may also lead to newborn jaundice (Source: Getty Images/Thinkstock) )

Risk factors

Babies who are born premature, have poor feeding, severe infection (sepsis), born to diabetic mothers, and those who have difficult labour with bruising are at an increased risk of jaundice. Excessive bilirubin production, because of rapid breakdown of red blood cells (called hemolytic jaundice), could be due to Rh, ABO and minor blood group incompatibility between the mother’s and the baby’s red blood cells.

Additionally, certain genetic disorders (Criggler Najjar, UGT1A1 mutation, Gilbert’s syndrome etc) reduces the liver’s ability to metabolise or break down bilirubin. Certain enzyme defects like G6PD deficiency also cause excessive jaundice. One of the common types is the breastfeeding failure jaundice that occurs due to lactation failure in the first week of life due to insufficient intake, weight loss and significant dehydration in the baby. Frequent breastfeeding with lactational support is usually the line of treatment recommended.

Typically, jaundice peaks on day 3 to 5 of life. Though visual inspection of the skin colour is useful, it is not always accurate. “We rely on measurement of bilirubin level in blood. Most babies born in a hospital will have a visual inspection of skin along with bilirubin checks on day 3 of life (after 48 hours of life). There are guidelines to help determine which babies need treatment and those who can be managed without,” he explained.

Prevention and care

Prevention of severe jaundice in healthy babies is important. This involves three general principles –

1. Universal systematic assessment before discharge – Before discharge, total bilirubin is measured and checked to see if treatment is required. Additionally, it is crucial to provide parental counselling for them to understand the warning signs of severe jaundice.

2. Close follow up – Babies need to be followed up closely in the first two weeks to assess for signs of jaundice, weight gain and general activity.

3. Prompt intervention when indicated – This includes admission to hospital, feeding support and phototherapy.

The basic test to assess jaundice is serum bilirubin. If this level is raised, then one needs to find out the reason depending on the clinical history. Checking the mother’s blood group, Rh type and presence of any antibody, checking hematocrit (an estimate of the red blood cell concentration), Coombs’ test (detects if RBCs are being broken down) help.

Jaundice in newborns is treated by using a special type of ultraviolet light which converts the jaundice pigment to a water soluble form that is then removed from the body. Phototherapy is simple, safe and effective in treating jaundice. It causes no long-term problems for the baby, Dr Vishwanath said.

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