Jaundice is a yellowish discoloration of the skin and the whites of the eyes. It is caused by too much of a chemical called bilirubin in the blood.
What is going on in the body?
The hemoglobin molecule in a red blood cell carries oxygen to all the cells in the body. Each hemoglobin molecule contains four molecules of iron. The body usually separates and recycles iron from hemoglobin molecules when the red blood cell has reached the end of its life and has broken down.
Bilirubin is a normal chemical by-product of this recycling process. The body does not need bilirubin. Bilirubin travels through the blood to the liver, where it is chemically converted into a form that can be excreted in the urine. When a child or adult has too much bilirubin in their blood, they become jaundiced.
After birth, it takes a few days for the newborn's liver to start processing bilirubin. It may take longer in infants who are born prematurely or who are breast-fed. About 80% of premature infants and 60% of full-term infants will have some visible jaundice.
Most of the time, mild jaundice is a normal condition, is not harmful, and will go away without treatment.
Sometimes, however, the bilirubin level can become too high or stay high for too long, and in these cases, treatment is required.
There are two main causes for too much unprocessed bilirubin - either more bilirubin is being made than can be processed, or the baby for some reason cannot get rid of the processed bilirubin.
What are the causes and risks of the condition?
A baby born prematurely is more at risk for jaundice. Infection, not getting enough oxygen during birth, and some medicines may increase the baby's risk of jaundice.
Some common causes of jaundice due to elevated levels of bilirubin include:
- a baby's blood type that is different from the mother's. For example, the mother has blood type O+, and baby is B+.
- a collection of blood, called a hematoma, between the scalp and the skull from pressure on the head during the birthing process. If there is a lot of blood, too much bilirubin can result.
- an identical twin who gets more blood than the other twin in the uterus. The baby who gets more blood can develop jaundice after it is born.
- inherited defects of the red blood cell
Jaundice from the baby's inability to remove bilirubin can be caused by the following conditions:
- babies with certain blood infections
- a blockage or cyst on the baby's bile duct
- genetic disorders, such as Down syndrome
- medicines, such as antibiotics
- thyroid abnormalities
What can be done to prevent the condition?
Some cases of newborn jaundice can be avoided by providing good prenatal care to the mother. The amniotic fluid can be tested to see if the unborn child is likely to be born with a high bilirubin level. If there are problems, the unborn child might need a blood transfusion. There are also medicines the mother can take to help prevent the condition.
How is the condition diagnosed?
Blood tests are done to find out how much bilirubin is present and why. The parents are asked if there might be any inherited causes. The health of the mother and baby during the pregnancy may give answers. The baby is examined for infection, anemia, liver disease, and other problems. An ultrasound examination of the liver and bile duct system might be needed. A sample of cells from the infant's liver may be required for a biopsy.
Long Term Effects
What are the long-term effects of the condition?
Infants who suffer brain damage from very high levels of bilirubin may develop severe symptoms. These include a high-pitched cry, body stiffness, and seizures. Some of these infants die. Those who survive will develop symptoms as they age. By age 3, they may develop a type of cerebral palsy, seizures, mental retardation, hearing impairment, speech impairments, and eye muscle disorders.
Some infants may be only mildly affected. They may lack muscular coordination and may develop partial deafness and attention deficit disorders. Infants who develop an obstruction in the bile ducts will need surgery. The surgery does not always work. If not, a liver transplant may be the only hope for long-term survival.
What are the risks to others?
Newborn jaundice is not contagious and poses no risk to others.
What are the treatments for the condition?
Very high levels of unprocessed (indirect) bilirubin can cause permanent damage to the brain. High levels of processed (direct) bilirubin are not as toxic, but still suggest the need for prompt attention.
Most infants with newborn jaundice can be treated with special lights used for phototherapy. Unprocessed bilirubin in the skin can be processed if it is exposed to fluorescent light. Focused halogen lights and fiber-optic, wrap-around blankets have also been used. With training and supervision, the infant's parents can use these treatments at home.
Some types of jaundice cannot be treated with phototherapy. An exchange transfusion may be needed in these cases. A catheter is inserted into the belly button, or umbilicus. A small amount of the baby's blood is removed. It is immediately replaced with donor blood. This is repeated until enough blood has been exchanged. Then the bilirubin level is measured at intervals. This procedure has risks and should be done only by trained staff with proper equipment.
Breast milk jaundice is harmless. It will quickly go away and not come back if the mother stops breast-feeding for 24 to 48 hours. Formula is used during this time to keep the newborn nourished.
What are the side effects of the treatments?
Because phototherapy can be harmful to the newborn's eyes, they must be protected.
Exchange transfusion can cause changes to the acid levels in body fluids, called metabolic acidosis. It can also cause low blood glucose or calcium levels, changes in heart rate, and inadequate breathing.
The baby may need resuscitation. Clotting or infection of the umbilical vein could result in liver complications. Surgery can be complicated by infection or bleeding after the operation.
What happens after treatment for the condition?
Most cases of newborn jaundice resolve without any further problems. Underlying problems, such as liver disease, may require further treatment.
How is the condition monitored?
Infants who have transfusions must be watched carefully. They can develop anemia, which is a low red blood cell count, or blockage of the bile ducts. Inherited diseases causing jaundice and conditions requiring surgery need long-term follow-up care. Any new or worsening symptoms should be reported to the healthcare professional.