Neonatal Jaundice

Neonatal jaundice treatment

Last Updated December 20th, 2021

Overview of neonatal jaundice

The Center for Disease Control and Prevention (CDC) has estimated that nearly 200 million people worldwide are suffering from jaundice at present. A large percentage of this population is found to have jaundice right at the time of birth. This is called neonatal jaundice, which has become quite prevalent in different parts of the world at present. Studies have shown that nearly 60% of all the newborns have mild to moderate degree of jaundice. This has triggered the American Liver Foundation to organize health campaigns in order to educate the mass about relevant vaccinations which can prevent future risks of jaundice.

What is neonatal jaundice?

Neonatal jaundice infantNeonatal jaundice is the condition of elevated bilirubin at the time of birth. Bilirubin is a yellowish pigment present in hemoglobin (responsible for carrying oxygen in Red Blood Cells). An increase in the concentration of bilirubin above 3 mg per dL of blood causes jaundice. Neonatal jaundice typically presents as the yellowish discoloration of the skin, sclera (white membrane covering the eye-ball) and mucous membranes caused by abnormalities in bilirubin secretion by the liver or obstruction of the bile duct. Neonatal jaundice is precipitated by a number of clinical and environmental factors which will be discussed in the following sections.

What are the main causes of neonatal jaundice?

In the newborns, jaundice develops primarily due to two factors-

  • The breakdown of fetal hemoglobin as it is substituted by adult hemoglobin.
  • The incompletely formed and immature metabolic pathways of the liver which excrete bilirubin very quickly due to the absence of conjugation

Neonatal jaundice can be attributed to but not limited to a few other causes such as-

  • Biliary atresia
  • Intrahepatic cholestasis
  • Biliary duct insufficiency
  • Alpha 1-antitrypsin deficiency
  • Alagille syndrome

The general causes of neonatal jaundice can be broadly classified under two sections- unconjugated bilirubin and conjugated bilirubin. These are discussed below-

Conjugated bilirubin: It is one of the direct causes of neonatal jaundice. It can further be subdivided into the following –

  • Infections: The main sources of infections are- Sepsis, Hepatitis A, Hepatitis B and TORCH infections.
  • Metabolic: The main causes are- galactosemia, alpha-1-antitrypsin deficiency, cystic fibrosis, Dubin-Johnson syndrome and Rotor syndrome.
  • Drugs
  • Total parenteral nutrition
  • Idiopathic (of unknown origin)
  • Post-liver: The main factors behind the post-liver neonatal jaundice conditions are biliary atresia or bile duct obstruction. Two conditions may arise in this case- Alagille syndrome and Choledochal cyst.

Neonatal jaundice UVUnconjugated bilirubin: It can be subdivided into two categories- Hemolytic and Non-hemolytic causes. The hemolytic causes are further subdivided into intrinsic and extrinsic causes. These are discussed below-

Intrinsic causes: These comprise of three conditions-

  • Membrane conditions: The two primary conditions, in this case, are- spherocytosis and Hereditary elliptocytosis.
  • Enzyme conditions: Two conditions may arise namely- G6PD deficiency and Pyruvate kinase deficiency.
  • Globin synthesis defect: Two diseases commonly observed in this condition are- sickle cell disease and alpha-thalassemia.

Extrinsic causes: These comprise of two conditions-

  • Systemic conditions: The two commonly studied systemic conditions, in this case, are- Arteriovenous malformation and sepsis.
  • Alloimmunity: The two factors studied in this case are- Hemolytic disease of the newborn and Rh disease.

The non-hemolytic causes are discussed below-

  • Breastfeeding failure jaundice
  • Breastmilk jaundice
  • Cephalohematoma
  • Polycythemia
  • Urinary tract infection
  • Sepsis
  • Hypothyroidism
  • Gilbert’s syndrome
  • Crigler Najar syndrome
  • Gastrointestinal obstruction

What are the different types of neonatal jaundice?

Neonatal jaundice is of three main types- breastfeeding failure jaundice, breast-milk jaundice, and physiological jaundice.

Neonatal jaundice treatmentBreastfeeding failure jaundice: As the name implies, this type of jaundice occurs due to insufficient or a complete lack of breastfeeding. The low breast-milk intake leads to extremely inadequate bowel movements that are necessary to remove excess bilirubin from the child’s body. This results in enterohepatic circulation, which is characterized by an increased reabsorption of bilirubin from the intestines. This condition can be reversed by feeding appropriate quantity of breastmilk to the infant.

Breastmilk jaundice: This type of jaundice arises from biochemical factors. The high quantity of bilirubin, in this case, acts as an antioxidant. It usually takes place between the 6th to the 14th day after birth, when the bilirubin concentration reaches its peak. Breastmilk jaundice generally occurs in two conditions-

  • At birth, insufficient bacteria are present in the gut. Hence instead of being conjugated, the bilirubin is deconjugated by brush border β-glucuronidase and then reabsorbed. This process is known as enterohepatic circulation.
  • The breast-milk of some women contains a particular metabolite of progesterone, known as 3-alpha-20-beta-pregnanediol. This inhibits the action of UDPGA glucuronosyltransferase enzyme, which is responsible for the conjugation and excretion of bilirubin. This leads to elevated levels of bilirubin in the blood.

Physiological jaundice: Physiological jaundice is characterized by a raised level of unconjugated bilirubin during the first week. It occurs in two distinct phases-

Phase I:

  • Term infants: Jaundice lasts for around 10 days, accompanied by a rapid increase in serum bilirubin concentration up to 204 µmol / liter.
  • Preterm infants: Here, jaundice lasts for about 2 weeks, with a rapid rise of serum bilirubin up to 255 µmol / liter.

Phase II:

Here the bilirubin level drops to about 34 µmol / liter for two weeks. Two cases arise here-

  • Preterm infants: Phase II can last for more than 1 month.
  • Exclusively breastfed infants: Phase II can last for more than a month.

Diagnosis, treatment, & prevention

The two types of equipment used for diagnosis are-

  • Ingram icterometer: The color of the pale yellow skin is matched with the graded yellow lines to assess the bilirubin level.
  • Transcutaneous bilirubinometer

The treatment of neonatal jaundice is mainly done by administering phenobarbital or by conducting phototherapy. Exchange transfusions are recommended in the cases where the bilirubin level is greater than 428 µmol / liter. The various treatment methods include:

  • Phototherapy: This includes exposing the baby to special blue lights (keeping the genitals and eyes covered). This helps in cutting down the bilirubin levels.
  • Sunlight Exposure: Once the phototherapy is over and the infant is discharged, the parents are advised to expose the infant to sunlight (before 9 am and after 4 pm) to get rid of excess bilirubin.
  • Intravenous Immunoglobulin: This method is used in case of severe cases of neonatal jaundice. This is used when the above two methods fail to improve the condition.

There are no guaranteed ways to prevent neonatal jaundice. If there is a mismatch between the Rh factor of the mother and the baby, the probability of neonatal jaundice increases. By following certain measures, one can ensure a fast recovery from the condition. This includes:

  • Frequent breastfeeding.
  • Preventing dehydration of the baby
  • Closely monitoring the symptoms and seeking immediate medical help if any abnormality occurs.

TL;DR?

 

Facts

  • Studies suggest that roughly 60% of all babies suffer from neonatal jaundice.
  • The risk factors associated with this condition are being preterm, belonging to Asian or Mediterranean descent, and having a darker skin tone.

Facts

  • Neonatal jaundice affected babies should be breastfed at least 8-12 times a day for the initial days. This will help get rid of bilirubin fast.
  • For a 2 day old infant, a bilirubin level of 12mg/dL can be quite dangerous, but the same level for a 3 day old baby is considered relatively safer.

Facts

  • If the bilirubin level reaches a high level of 20-30 mg/dL, it predisposes the infant to conditions such as kernicterus and even hemolytic anemia.

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Dos and Don'ts

Dos
  • Make sure that the baby is fed frequently throughout the day during the course of the condition.
  • It is important for the baby to get some sunlight for faster healing.
  • Seek immediate medical help if your contractions start before your due date. This is one of the risk factors for neonatal jaundice.
Don'ts
  • Skip routine check-ups with the pediatrician.
  • Ignore the symptoms of neaonatal jaundice. If not treated in time, it can lead to serious brain damage to the infant.
  • Panic if your baby starts showing visible symptoms of jaundice. It is a fairly common condition.

 

 

 

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Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
Jackfruit: Slice your way into higher immunity, better digestion, & more… Native to the South East Asia, the jackfruit is a fruit brimming with thousands of health benefits. Discover…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
Epley maneuver: Why is this the best protection from the symptoms of vertigo? Epley maneuver is an exercise that can treat the symptoms of benign paroxysmal positional vertigo (BPPV).  It was…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
Atkins diet weight loss
Atkins Diet: The right steps to carb control that can help you lose those pounds fast The Atkins diet is a high fat, low-carb diet with proven weight loss benefits that is flexible enough…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
chloride test
Chloride Test A chloride test of the blood checks the level of chloride in body, an important factor governing the…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
valproic acid test
Valproic Acid Test Valproic acid test is performed to generally check for psychiatric and even neurological conditions such as bipolar disease…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
acne removal tips
Anatomy of acne: 7 instant steps to kiss those zits goodbye Blackheads, whiteheads, or pimples-call them what you may. Acne is never good news.Did you know some of the…