Bringing a newborn into the world is an exhilarating experience filled with joy, hope, and countless new beginnings. However, it can also come with its share of challenges, one of which is newborn jaundice, a condition characterised by yellowing of the skin and eyes. It a common condition globally and affects approximately 60% of full-term newborns and 80% of preterm infants. It is usually harmless and resolves without treatment although in some cases medical intervention is required.

Understanding newborn jaundice, its diagnosis, treatment options, and potential long-term implications can help you manoeuvre your way through the maze of parenting. And that’s exactly what we will do today.

Symptoms of Newborn Jaundice

Newborn jaundice is typically identified by the following symptoms:

• Yellowing of the Skin and Eyes: A yellow tint starting on the face and then spreading to the chest, abdomen, arms, and legs. The whites of the eyes (sclera) may also appear yellow.
• Poor Feeding or Difficulty Feeding: Babies with jaundice might be lethargic and have trouble feeding properly.
• Dark Urine: Despite the limited fluid intake, the urine might appear darker than usual. Newborns usually have very light or colourless urine.
• Pale or Light-Coloured Stools: Lighter than usual stools in breastfed babies, particularly if they become pale, can indicate a potential issue.
• Lethargy or Sleepiness: Excessive sleepiness and difficulty waking the baby can be a sign of rising bilirubin levels.

Causes of Newborn Jaundice

The primary causes of newborn jaundice include:

• Physiological Jaundice: Newborns, especially those born prematurely, often have immature liver enzymes that are less efficient at processing bilirubin. This is the most common cause of jaundice and usually appears 2-3 days after birth, resolving within two weeks without treatment.
• Breastfeeding Jaundice: This type of jaundice can occur when a newborn does not receive enough breast milk, leading to reduced bilirubin excretion and dehydration. It usually appears in the first week of life.
• Breast Milk Jaundice: Unlike breastfeeding jaundice, this condition arises from substances in breast milk that can interfere with bilirubin breakdown. It usually appears after the first week of life and can last for several weeks.
• Haemolytic Jaundice: Conditions like Rh incompatibility or ABO incompatibility can lead to the destruction of red blood cells, releasing large amounts of bilirubin into the bloodstream. Conditions such as Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency or hereditary spherocytosis can cause increased red blood cell breakdown, leading to high bilirubin levels.
• Other Causes: Infections can damage the liver and increase red blood cell breakdown, contributing to higher bilirubin levels. Bleeding into a region of the baby’s body, such as under the scalp, can result in an increased breakdown of red blood cells. Conditions such as Gilbert’s syndrome or Crigler-Najjar syndrome can impair the liver’s ability to process bilirubin efficiently.

Risk Factors

Certain factors increase the risk of a newborn developing jaundice such as:

• Prematurity: Preterm infants have less developed livers, which are less efficient at processing bilirubin. Moreover, Preterm babies often have more fragile red blood cells that break down more easily.
• Genetic Factors: A family history of jaundice or inherited conditions affecting red blood cells or liver function can increase the risk. Some ethnic groups, such as East Asian and Mediterranean populations, have a higher incidence of jaundice-related conditions like G6PD deficiency.
• Feeding Difficulties: Babies who have trouble breastfeeding or do not get enough breast milk may have higher bilirubin levels. Inadequate fluid intake can concentrate bilirubin in the blood.
• Birth Factors: Bruising or other injuries during birth can increase red blood cell breakdown. Accumulation of blood under the scalp due to birth trauma can lead to increased bilirubin production.
• Blood Group Incompatibility: If the mother’s blood type is incompatible with the baby’s, it can lead to increased destruction of red blood cells and higher bilirubin levels.
• Infections: Infections contracted before or after birth can impair the liver’s ability to process bilirubin.
• Medical Conditions: Babies born to mothers with diabetes are at higher risk of jaundice. Larger babies have more red blood cells, which can increase bilirubin levels when these cells break down.
• Maternal Factors: Some medications taken by the mother during pregnancy can affect the baby’s bilirubin levels. Certain medical conditions such as delayed clamping of the umbilical cord can lead to an increased blood volume and higher bilirubin levels.

Treatment of Newborn Jaundice

The treatment approach for newborn jaundice depends on the severity and underlying cause. Here are the common treatment options:

• Phototherapy: This is the most common treatment for newborn jaundice. The baby is placed under special blue spectrum lights that help break down bilirubin in the skin. Phototherapy is usually effective and safe, and it can be administered in the hospital or at home with portable units.
• Intravenous Immunoglobulin (IVIg): For jaundice caused by blood group incompatibility, this can lead to a reduction in the need for exchange transfusion by decreasing the level of antibodies attacking the baby’s red blood cells.
• Exchange Transfusion: In severe cases, an exchange transfusion might be necessary. This procedure involves gradual removal of small amounts of the baby’s blood and replacing it with donor blood to rapidly reduce bilirubin levels.
• Supplemental Feeding: Increasing the frequency of breastfeeding or supplementing with formula can help babies with breastfeeding jaundice by ensuring adequate hydration and promoting bilirubin excretion.
• Treating Underlying Conditions: If the cause of the jaundice is an underlying condition such as an infection or a genetic disorder, treating that condition is crucial to resolving the jaundice.

Long-Term Implications of Newborn Jaundice

Severe or untreated newborn jaundice can have serious complications, so it’s crucial to be aware of the potential risks for early intervention and prevention.

• Acute Bilirubin Encephalopathy: High levels of bilirubin can cross the blood-brain barrier, leading to acute bilirubin encephalopathy. Symptoms include lethargy, high-pitched crying, poor feeding, and arching of the body. Immediate treatment is required to prevent permanent damage.
• Kernicterus: If acute bilirubin encephalopathy is not treated, it can progress to kernicterus, a form of brain damage that can cause permanent neurological and developmental issues, such as hearing loss, cerebral palsy, and cognitive impairments. Kernicterus is rare but preventable with proper management of jaundice.
• Developmental Delays: Some studies suggest that even moderate levels of jaundice may be associated with subtle developmental delays or learning difficulties. Regular developmental screenings and early intervention programmes can help address these issues if they arise.
• Hearing Impairment: High bilirubin levels can affect the auditory pathways, potentially leading to hearing loss. Newborns with severe jaundice should undergo hearing screening to detect and address any hearing impairments early.
• Behavioural Issues: There is some evidence that severe jaundice might be linked to an increased risk of behavioural problems later in childhood. Early diagnosis and support can help mitigate these effects.

Prevention of Newborn Jaundice

While not all cases of jaundice can be prevented, certain measures can reduce the risk and severity:

• Adequate Feeding: Ensure frequent and effective breastfeeding to promote hydration and bilirubin excretion. Supplement with formula if breastfeeding is insufficient need to be used to maintain adequate nutrition and hydration.
• Monitoring: Babies at higher risk for jaundice, such as those born prematurely or with a family history of jaundice, should be closely monitored for signs of jaundice in the first few days after birth.
• Blood Type Screening: Pregnant women should be screened for blood type and Rh factor to identify potential incompatibilities. If incompatibility is detected, proactive measures can be taken to prevent severe jaundice.
• Educating Parents: Teach parents to recognise symptoms of jaundice, such as yellowing of the skin and eyes. Encourage parents to seek medical advice promptly if they observe signs of jaundice.
• Managing Maternal Health: Ensure good management of maternal diabetes, which can influence newborn health. Review and manage maternal medications that might affect the baby’s bilirubin levels.

Self-Care for Newborn Jaundice by Parents

Newborn jaundice is a common condition that usually resolves on its own, but proper self-care measures can help parents manage and monitor their baby’s condition effectively at home.

Here’s a guide for parents on how to care for a newborn with jaundice:

Feeding and Hydration

It is important to feed your baby frequently in order to help reduce bilirubin levels. For breastfed babies, aim to breastfeed every 2-3 hours during the day and at least once at night. For formula-fed babies, make sure they are consuming 2-3 ounces per feeding. If you are breastfeeding, ensure that your baby is latching properly and receiving enough milk. If you are experiencing difficulties, do not hesitate to seek guidance from a lactation specialist.

Light Therapy at Home

Place your baby in indirect sunlight for short periods (10-15 minutes) a few times a day. Sunlight helps break down bilirubin in the skin. Ensure your baby is lightly clothed and avoid direct sunlight to prevent sunburn. If prescribed, use a special light blanket or bed that emits blue light, which helps reduce bilirubin levels. Follow your healthcare provider’s instructions on how to use the phototherapy equipment.

Comfort and Care

Keep your baby in a comfortable and safe environment. Ensure the room is neither too hot nor too cold. Keep your baby’s skin clean and dry. Frequent diaper changes and gentle cleaning help prevent rashes, which can occur in babies undergoing phototherapy.

Recognise Warning Signs

If the yellowing becomes more pronounced and spreads to the arms and legs, seek medical advice immediately. Contact your healthcare provider if your baby shows signs of extreme sleepiness, difficulty waking, poor feeding, or high-pitched crying. If jaundice lasts longer than three weeks or appears after the first week, consult your doctor.

Parental Well-Being

Educate yourself about newborn jaundice. Understanding the condition can help reduce anxiety and enable you to care for your baby more effectively. Don’t hesitate to ask for help from family, friends, or healthcare providers if you feel overwhelmed.

Sources:

• https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes
• https://www.healthline.com/health/newborn-jaundice
• https://my.clevelandclinic.org/health/diseases/jaundice-in-newborns
• https://www.nhs.uk/conditions/jaundice-newborn/
• https://medlineplus.gov/ency/article/001559
• https://www.healthychildren.org/English/ages-stages/baby/Pages/Jaundice
• https://www.cincinnatichildrens.org/health/j/jaundice
• https://www.marchofdimes.org/find-support/topics/planning-baby/newborn-jaundice
• https://www.whattoexpect.com/baby-health-and-safety/newborn-jaundice.aspx