Neonatal Jaundice

Jaundice is also known as hyperbilirubinemia. It refers to an excessive accumulation of unconjugated bilirubin in blood which is resulting in yellowish discoloration of skin and mucus membrane. Other symptoms may include excess sleepiness or poor feeding.

In most of cases there is no specific underlying physiologic disorder. In other cases it results from RBC breakdown, liver disease, infection, hypothyroidism, or metabolic disorders (pathologic). A bilirubin level more than 34 μmol/L (2 mg/dL) may be visible. Concerns, in otherwise healthy babies, occur when levels are greater than 308 μmol/L (18 mg/dL), jaundice is noticed in the first day of life, there is a rapid rise in levels, jaundice lasts more than two weeks, or the baby appears unwell. 

The need for treatment depends on bilirubin levels, the age of the child, and the underlying cause. In those who are born early more aggressive treatment tends to be required. Physiologic jaundice generally lasts less than seven days. Babies that are born early about 80% are affected. Globally over 100,000 late-preterm and term babies die each year as a result of jaundice.

Types of Jaundice

1. Physiological Jaundice
2. Pathological Jaundice

Physiological Jaundice

Physiological jaundice develops within first week of life babies. About 60% term babies and 70% preterm babies develop jaundice within first week of life of babies. In term babies, maximum intensity of jaundice is on 4th day and subsides by 7th day. In preterm babies, maximum intensity of jaundice is on 5th-6th day and subsides by 14th day.

Pathological Jaundice

Pathological jaundice occurs within 24 hours of birth of babies. About 5% of newborns develop with pathological jaundice. In term babies, jaundice persists beyond 10 days and in preterm babies jaundice persists beyond 14 days.

Difference between Physiological and Pathological Jaundice

Physiological jaundice is normal. It does not present on day 1. Serum bilirubin (SBR) levels will peak by day 4 and reduces by day 14. Pathological jaundice, on the other hand, should raise concern and always requires further investigation.

Risk factors

Common risk factors for infant jaundice are:

• Premature birth – premature babies have severely underdeveloped livers and fewer bowel movements, this means there is a slower filtering and infrequent excretion of bilirubin.
• Breast-feeding – babies who do not get enough nutrients or calories from breast milk or become dehydrated are more likely to develop jaundice.
• Rhesus or ABO incompatibility – when a mother and baby have different blood types, the mother’s antibodies go through the placenta and attack the red blood cells of the fetus, causing accelerated break down.
• Bruising during birth – this can make red blood cells break down faster, resulting in higher levels of bilirubin.

Clinical Features

1. Yellowish discoloration of skin, sclera and nail
2. Dark urine and stool
3. Lethargy
4. Refuse to feed

Diagnostic Evaluation

1. Physical examination
2. Clinical estimation of jaundice
3. Serum bilirubin estimation

Management

1. Phototherapy-Phototherapy is treatment with a special type of light (not sunlight). It is used to treat newborn jaundice by making it easier for your baby’s liver to break down and remove the bilirubin from your baby’s blood. Phototherapy aims to expose your baby’s skin to as much light as possible.
2. Exchanged blood transfusion
3. Pharmacologic management- Phenobarbitone, Metalloporphyrins