20 Jun

Jaundice In New Born Babies

Last week my young intern called, when we all took time off, that her 2 day old nephew had to be taken to the hospital because of a noticed eye discolouration. I wondered what that could be.  She told me later that he was diagnosed as having ‘jaundice’.  Then I remembered that a cousin had similar problem when we were kids.
So I decided to research and write about that ‘common condition’ that can inflict new born babies just in case someone is out there panicking at the colour ‘yellow’ observed.
Jaundice also known as hyperbilirubinaemia, is caused by too much bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells are broken down. The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so it can be passed out of the body in poo.
However, if there’s too much bilirubin in the blood or the liver can’t get rid of it, excess bilirubin causes jaundice.
Babies have jaundice because their liver isn’t fully developed yet so it cannot process the bilirubin yet. By the time the baby is two weeks old, they produce less and the liver would have been strong enough to remove the bilirubin. Which means the jaundice heals itself at this point.
Breastfeeding too can cause jaundice, but this is not enough reason to stop breastfeeding as the jaundice would pass by itself. The reason why breastfed babies are at higher risk of jaundice is unclear although scholars have suggested a number of reasons part of which is that the breastmilk contains substances which reduce the ability of the liver to process bilirubin. This is called breastmilk jaundice.

Underlying health conditions

In some cases, jaundice may be the result of another health problem. This is sometimes called ‘pathological jaundice’.
Some causes of ‘pathological jaundice’ include:
  • An under active thyroid gland )hypothyroidism) – where the thyroid gland doesn’t produce enough hormones
  • Blood group incompatibility – when the mother and baby have different blood types, and these are mixed during the pregnancy or the birth
  • Rhesus factor condition – a condition that can occur if the mother has rhesus-negative blood and the baby has rhesus-positive blood
  • A urinary tract infection
  • Crigler-Najjar syndrome – an inherited condition that affects the enzyme responsible for processing bilirubin
  • aAblockage or problem in the bile ducts and gallbladder – these create and transport bile, a fluid used to help digest fatty foods
An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD) could also lead to jaundice or kernicterus
If you have a family history of G6PD, it’s important to let your midwife, GP or paediatrician know and your baby’s jaundice symptoms are closely monitored.

 Symptoms of infant jaundice

The most pervasive sign of infant jaundice is yellow skin and sclerae (the whites of the eyes). This typically starts at the head, and spreads to the chest, stomach, arms and legs.
  • Yellow skin and sclerae (the whites of the eyes)
  • Drowsiness
  • Itchy skin
  • Pale stools – breastfed babies should have greenish-yellow stools, while those of bottle fed babies should be a greenish-mustard color.
  • Poor sucking/feeding
  • Dark urine – a newborn’s urine should be colorless.

Symptoms of severe infant jaundice include:

  • Yellow abdomen or limbs
  • Drowsiness
  • Yellow sclerae (whites of the eyes)
  • Inability to gain weight
  • Poor feeding
  • Jaundice that lasts over three weeks.

Treatments for infant jaundice

Typically, treatment for mild jaundice in infants is unnecessary, as it tends to disappear on its own within two weeks.
If the infant has severe jaundice they may need to be readmitted to the hospital for treatment to lower levels of bilirubin in the bloodstream.
Some treatment options for severe jaundice include:
·         Phototherapy (light therapy) – treatment by light rays. The baby is put under a special light, covered by a plastic shield to filter out ultraviolet light, that manipulates the structure of bilirubin molecules so they can be excreted; sometimes it is useful to use a light-emitting mattress under the baby as well. Usually the baby is naked, wearing only protective eye patches.
·         Exchange blood transfusion – the baby’s blood is repeatedly withdrawn to filter out bilirubin and then transferred back into the bloodstream. This procedure will only be considered if phototherapy does not work because the baby would need to be in an intensive care unit (ICU) for newborns.
·         Intravenous immunoglobulin (IVIg) – if there is a difference in blood type, the infant can get a transfusion of immunoglobulin, a protein in the blood that can lower levels of any remaining antibodies from the mother, which may be attacking the infant’s red blood cells.
If jaundice is caused by something else, surgery or drug treatment may be required.

Complications that could occur from infant jaundice

·         Acute bilirubin encephalopathy – a condition caused by a buildup of bilirubin in the brain (bilirubin is toxic to brain cells). Signs of acute bilirubin encephalopathy in a baby with jaundice include fever, sluggishness, high-pitched crying, poor feeding, and arching of the body or neck. Immediate treatment may prevent further damage.
·         Kernicterus (nuclear jaundice) – a potentially fatal syndrome that occurs if acute bilirubin encephalopathy causes permanent brain damage.

Prevention of infant jaundice

The best way of reduce chances of an infant developing jaundice is to make sure they are well fed. For the first week or so of life, breastfed babies should be fed eight to twelve times a day, while formula-fed babies should be fed one to two ounces of formula every two or three hours.
In all, when you notice anything out of sync with your new born baby, do not delay or try to self-medicate – go to the professional – the Paediatrician!

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