What is Neonatal Jaundice?

Jaundice is a yellowish discoloration of the skin, mucous membranes and of the white of the eyes caused by elevated levels of the chemical bilirubin in the blood (hyperbilirubinemia).  Jaundice is not a disease, but rather a visible sign of an underlying disease process. A yellow pigment produced during normal breakdown of red blood cells. Most infants born between 35 weeks' gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

• Newborn jaundice occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool. A high level of bilirubin makes a baby's skin and whites of the eyes look yellow. This is called jaundice.
• Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital.
• Jaundice is the most common condition that requires medical attention and hospital readmission in newborns. The yellow coloration of the skin and sclera in newborns with jaundice is the result of accumulation of unconjugated bilirubin.
• In most infants, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon. However, in some infants, serum bilirubin levels may rise excessively, which can be cause for concern because unconjugated bilirubin is neurotoxic and can cause death in newborn.

Symptoms of Neonatal Jaundice

The signs of the baby getting jaundice are when you see the skin and the baby's white eyes becoming yellowish. This usually occurs between the second and the fourth day after birth. The first colour appears on the face, followed by the chest, abdomen, arms, and legs in sequence.

How to Check?

• To check if the baby gets jaundice, slowly press the baby's forehead or nose. 
• If the skin looks yellow where you press, your baby may have jaundice. For your baby to be healthy, the colour will look brighter than normal skin colour. 
• This technique is great for bright skinned children; If your baby has dark skin, the way is to check the yellowish colour on the white or gums. 
• You will also find that your baby's stools are pale.

Bilirubin Level

• The above graph shows the changes in billirubin level in baby which affects the neonatal jaundice in baby. According to the graph, when a baby's age increases in (hours), the level of   bilirubin increase. For example, when the baby is 132(hours), the billirubin level is 200-300L, which makes the increase of jaundice in a baby.

Neonatal Jaundice in Babies

• The graph above shows the frequency level of billirubin in a baby which shows the time taken to seek medical consultation when the Neonatal Jaundice in noticed in a baby. According to the blog, when the baby is 24 hours younger, the baby should be brought to the medical consultation as the frequency of jaundice would be higher. For example, when baby is lesser than 24 hours old, the frequency level is 86.12%.

Factors Affecting Neonatal Jaundice

Infant jaundice is caused by an excess of bilirubin. Bilirubin is a waste product, produced when red blood cells are broken down. It is normally broken down in the liver and removed from the body in the stool.

Before a baby is born, it has a different form of hemoglobin. Once they are born, they very rapidly break down the old hemoglobin. This generates higher than normal levels of bilirubin that must be filtered out of the bloodstream by the liver and sent to the intestine for excretion.

However, an underdeveloped liver cannot filter out the bilirubin as fast as it is being produced, resulting in hyperbilirubinemia (an excess of bilirubin).

Infant jaundice with breast-feeding is common. It occurs in newborns that are breast-fed in two separate forms :-
a) Breast-feeding jaundice - occurs in the first week of life, if the baby does not feed well, or if the mother's milk is slow to come in.
b) Breast milk jaundice - this is due to how substances in the breast milk interfere with the breakdown process of bilirubin. It occurs after 7 days of life, peaking at 2-3 weeks.

Complications/Effects of Jaundice

Some cases of severe infant jaundice are linked to an underlying disorder, such as:

a) Kernicterus

Its a rare but serious complication of untreated jaundice in babies. It's caused by excess bilirubin damaging the brain or central nervous system.In newborn babies with very high levels of bilirubin in the blood (hyperbilirubinaemia), the bilirubin can cross the thin layer of tissue that separates the brain and blood (the blood-brain barrier).The bilirubin can damage the brain and spinal cord, which can be life threatening.Brain damage caused by high levels of bilirubin is also called bilirubin encephalopathy.

 Your baby may be at risk of developing kernicterus if:

• they have a very high level of bilirubin in their blood
• the level of bilirubin in their blood is rising rapidly
• they don't receive any treatment

Liver Disease:
Infant jaundice usually occurs because a baby's liver isn't mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice. Most infants born between 35 weeks' gestation and full term need no treatment for jaundice.

Blocked bile duct or bowels:

a yellow coloring of the skin and eyes due to a very high level of bilirubin (bile pigment) in the bloodstream. Jaundice caused by an immature liver is common in newborns. It usually goes away within the first week to 10 days of life. A baby with biliary atresia usually appears normal at birth, but develops jaundice at two or three weeks after birth.

Abnormal Red Blood Cells:

Conditions that cause accelerated destruction of red cells, which can occur as a result of immune-mediated hemolysis, certain enzyme deficiencies, or structural abnormalities in red cells.

Treatmeant for Jaundice

Extra feedings
Taking in more breast milk or formula will help your baby poop more often, which can help clear out bilirubin from the body. Or, if your baby is having trouble breastfeeding, your doctor may recommend you feed him breast milk from a bottle or also feed him formula.

Phototherapy

In this treatment, the doctor puts your baby under blue-green lights. It can help bilirubin leave his body in his urine. He'll wear a diaper only so that most of his skin can soak up the light. He'll wear patches to protect his eyes. The light may come from a special pad or mattress that puts out blue-green light.

Intravenous immunoglobulin (IVIg) 

If your baby's jaundice happens because he has a different type from his mom, your doctor may need to give him a blood protein through an IV that helps stop the breakdown of red blood cells.

Exchange transfusion

If your baby has severe jaundice that isn't getting better with other methods, he may need a blood transfusion called an exchange transfusion. In this process, your doctor draws small amounts of your baby's blood and replaces it with blood from a donor.

Conclusion

• Jaundice is easily diagnosable however require quick and on the spot treatment. If not treated properly, it leads to many complications.
• Currently the treatment options for jaundice include photo therapy, chemotherapy, and vaccinations. Neonatal jaundice is an important aspect of neonatal morbidity. There are well-developed systems to identify, investigate and manage the problem in developed health care systems, but much research and development is still needed to address the problem in resource-poor settings.
• Every newborn should be assessed for the risks of developing sever hyperbilirubinemia postnattaly. Assessment of clinical risk factors are important to avoid the hazards of sever hyperbilirubinemia and its threat of brain damage.
• Exclusive breastfeeding decrease the incidence of neonatal jaundice compared to bottle feeding, but if these infants are starved or dehydrated, they could probably be at higher risk of bilirubin encephalopathy. There is no effect of oxytocin used for labor induction in the incidence of neonatal jaundice.
• Medical scientists should search for new treatments and preventive measures having no side effects and capable of recovering babies more speedily. Partners should screen their ABO blood groups as well as Rh factor before marriage. Consanguineous marriages should be avoided. It is believed that this will help reduce the effects of jaundice on children's health and well-being in developing countries in the world.

Prezi & Youtube

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