Worried about your newborn having jaundice? Don’t be! It’s normal for all babies to have jaundice a few days after birth. While jaundice is more common in premature babies (babies born before the 37th week of pregnancy), about 6 out of 10 newborns have jaundice and its timely treatment can help your baby from developing further complications. Read on to understand what causes jaundice in babies, what are the early signs and symptoms, its diagnosis and treatment.
What is Jaundice?
If your baby is born with yellow eyes and skin, then he/she has jaundice. Jaundice (medically known as hyperbilirubinemia) is a common health problem seen in the first week of your baby’s life. The yellowish tinge of the skin occurs because there is too much bilirubin in your baby's blood.
Bilirubin is a yellow substance that forms as a result of the breakdown of your baby’s red blood cells (RBCs). RBCs are the cells that supply oxygen (the life-supporting gas) to all the cells of your baby’s body. Normally, bilirubin is carried through the blood to the liver (an organ located under the rib cage on the right side of the abdomen which stores food and releases wastes from the body), where it is excreted into bile, the green pigment made by the liver. Then it moves out of the body as waste.
Your newborn’s liver does not remove bilirubin immediately after birth. Jaundice happens when bilirubin builds up faster than the liver can break it down and pass it from the body.
Remember that your newborn has excess red blood cells that have to be broken down as well. As a result, there is a higher level of bilirubin in your baby after birth which imparts the yellow colour.
Based on the recent recommendations of the AAP (American Association of Pediatrics), bilirubin levels up to 17–18 mg/dl may be accepted as normal in healthy newborns. Mg/dL or milligrams per deciliter is a measurement that indicates the amount of a particular substance (such as glucose) in a specific amount of blood.
Types of Jaundice in Babies
Several types of jaundice reported in babies depend on the causative factor. The most common ones are:
1. Physiological Jaundice. This is the most common type of newborn jaundice, that has no serious consequences. In rare cases, there are high toxic levels of bilirubin.
Physiological jaundice usually appears between 24 to 72 hours of age and peaks around the 4th and 5th days and disappears by 10 to 14 days of your baby’s life.
2. Pathological Jaundice. Bilirubin levels with a deviation from the normal range can be termed as pathological jaundice. Jaundice appears within 24 hours of your baby’s birth and peak beyond the expected levels.
Your baby might show signs and symptoms that are indicative of a serious illness.
Pathological jaundice demands clinical treatment to reduce complications.
3. Breastfeeding Jaundice (BFJ). Is an exaggerated form of physiological jaundice that is associated with insufficient milk intake. Breastfeeding, also known as nursing, is the feeding of your milk from your breast (mammary glands that produce milk after childbirth).
Breastfeeding jaundice is the result of your baby not receiving enough milk to lower his/her bilirubin levels.
It follows the same pattern as that of physiological jaundice. It usually appears between 24 to 72 hours of age, peaks between 5 to 15 days of life and disappears by the third week of life.
You are encouraged to breastfeed your baby at frequent intervals (at least 10 to 12 times per day). Check with your doctor to know more about this.
4. Breast Milk Jaundice (BMJ). BMJ occurs between 1 and 12 weeks in infants fed on breast milk. Breast milk, also known as mother's milk, contains healthy bacteria, antibodies, white blood cells, antimicrobials, cell wall protectors, immunoglobulins, proteins, enzymes and hormones that protect your baby from illnesses.
Sometimes, breast milk prevents the liver from quickly removing bilirubin. This is called breast milk jaundice and happens after the first week of life. It is postulated that breast milk jaundice may be caused by substances in the breast milk that block the proteins in the liver which are responsible for bilirubin breakdown. Breast milk jaundice is a temporary condition and the bilirubin levels slowly improve over 3 to 12 weeks.
Check with your doctor as to how many times a day you can breastfeed your baby in case he/she is diagnosed with breast milk jaundice.
Breast milk jaundice is actually not related to breastfeeding jaundice. Breastfeeding jaundice develops in infants that have difficulty in breast-feeding and do not get enough breast milk whereas breast milk jaundice infants can properly latch on the breast and receive an ample amount of breast milk.
What Are the Signs & Symptoms of Jaundice?
Your baby’s skin looks yellow, on the face, chest, stomach, and legs. The white portion of your baby's eyes (called sclera) may also look yellow. Other symptoms that can be seen in your baby include:
Sleepiness
Fussiness
Floppiness (keeping soft and tender limbs, unable to stay stern)
Have trouble feeding
If your baby has a slightly dark skin tone, then it might be hard to see the yellow tinge and identify the presence of jaundice. To check, gently press the skin on your baby's nose or forehead. If your baby’s skin appears yellow after you lift your finger, then he/she might have jaundice.
How to Diagnose Jaundice in Newborns?
Your newborn has to be checked for jaundice before he/she leaves the hospital. A light machine is used to check your baby’s bilirubin levels. If the bilirubin levels are high, your obstetrician/gynaecologist/paediatrician might recommend a blood test to confirm the results of the light machine test.
How Is Jaundice Treated?
Most types of jaundice go away on their own. Others need treatment to lower bilirubin levels.
Your baby’s body starts to get rid of bilirubin in about a week or two and thus mild jaundice goes away on its own.
If your newborn has breastfeeding jaundice, then you have to breastfeed him/her more often.
In case of severe jaundice, the following treatments can be given to your baby:
1. Intravenous (IV) fluids. A loss of excess fluids (dehydration) can cause bilirubin levels to rise in your baby. IV fluids are liquids given to replace water, fluids, and salt in your baby’s body. Extra fluids will lead to frequent urination and increase bilirubin excretion.
2. Phototherapy. In this method, your baby is put under lights with little clothing to protect the skin. The light changes the bilirubin to a form that can easily pass out of your baby’s body.
In phototherapy, shining fluorescent lights from bili-light to break down the bilirubin. This procedure is safe and effective and can be done only in the hospital.
3. Exchange blood transfusion is a potentially life-saving procedure that is done to counteract the effects of serious jaundice. This is an emergency procedure that is done if the bilirubin levels of your baby do not come down with phototherapy. Your baby's blood is replaced with blood from a donor to quickly lower bilirubin levels.
Talk to your doctor to understand the associated risks of this procedure. While it is considered safe, there are risks of certain infections being spread to your baby while transfusion.
What Are The Complications and When Should You Call The Doctor?
Call your doctor right away if your baby starts to look very sick, is sleeping longer than usual, has suddenly stopped feeding properly, and if other symptoms of jaundice get worse.
Remember to call the doctor if your baby’s symptoms aren’t getting any better. If jaundice lasts longer than 2 weeks, your baby might require more testing to check for other infections.
References:
1. Sana ULLAH, M., 2021. Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article. [online] PubMed Central (PMC). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935699/> [Accessed 2 February 2021].
2. Centers for Disease Control and Prevention. 2021. What are Jaundice and Kernicterus? | CDC. [online] Available at: <https://www.cdc.gov/ncbddd/jaundice/facts.html> [Accessed 2 February 2021].
3. Jaundice in newborns. Paediatr Child Health. 2007;12(5):409-420. doi:10.1093/pch/12.5.409
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