Jaundice in Newborns (Neonatal Jaundice)-The word Jaundice is derived from the word jaune, which means yellow in French. Jaundice is not technically a disease, rather it is a visible sign of an abnormal condition causing increased levels of bilirubin in the blood. Jaundice is the yellowish pigmentation of the skin, mucous membranes and the whites of the eyes (sclerae) due to increased levels of bilirubin in the blood (hyperbilirubinemia).

What causes Jaundice in newborns?

The accumulation of bilirubin in the blood causes Jaundice; typically from an elevated production of bilirubin or a decreased ability to metabolize and excrete it. Bilirubin is formed w hen red blood cells disintegrate and is normally metabolized in the liver and excreted through urine and feces.

Neonatal Jaundice can be caused by various different conditions, and it is commonly seen in newborns. The most reported cause in newborns is physiologic Jaundice, which affects most newborns and is often benign. However, there are some of the other causes of neonatal Jaundice as well, mentioned below:

Physiologic Jaundice

  • Physiologic Jaundice is usually evident on the 2nd or 3rd day of  birth. It is the most common cause of neonatal Jaundice and it is usually a transient and harmless condition
  • It is caused by the inability of the newborn’s immature liver to conjugate and thus excrete serum bilirubin, which accumulates due to the break-down of  the red blood cells which have a shorter life-span of 70 to 90 days than adult red blood cells’ life span of 120 days.
  • This increase in red blood cell breakdown and decreased ability to metabolize bilirubin overwhelms the newborns ability to properly process and excrete bilirubin from the body. As the baby’s liver ages, the Jaundice eventually disappears within 10-15 days.

Breast milk Jaundice

This form of Jaundice occurs in breast-fed infants and often appears at the 5th or 7th day of  birth. There are certain chemicals in breast milk, that are thought to be responsible. It is generally a harmless condition that disappears spontaneously. Mothers do not have to discontinue breastfeeding.

Breastfeeding  Jaundice

This form of Jaundice occurs when the breast-fed newborn does not get required breast milk intake. This may occur because of delayed or insufficient milk production in the mother. This insufficient intake results in dehydration and fewer bowel movements for the newborn, which hampers the bilirubin excretion from the body. 

Maternal-fetal blood group incompatibility (Rh, ABO)

This form of Jaundice occurs when there is incompatibility between the blood types of the mother and the fetus. This condition to increases bilirubin levels from the breakdown of the fetus’ red blood cells (hemolysis).

Deposition of blood under the scalp (Cephalohematoma)

At times during birth, the newborn may bear a bruise or injury on the head, that results in a blood clot under the scalp. As this blood is naturally conjugated, sudden increased levels of bilirubin may overrun the processing capacity of the newborn’s immature liver; thus resulting in Jaundice.

Red blood cell enzyme defects

Inherited genetic enzyme disorders can also lead to increased hemolysis and subsequent elevation in bilirubin levels.

Red blood cell membrane defects

Abnormalities in the membrane and the shape of red blood cells (for example, spherocytosis) may lead to increased hemolysis.

Symptoms of Jaundice in newborns

  •  Poor feeding
  • Light-colored stool
  • Yellowish discoloration of the skin, mucous membranes and the whites of the eyes
  • Lethargy/excessive sleepiness
  • High-pitched crying
  • Seizures

Diagnosis

Neonatal Jaundice can be diagnosed by examining the newborn and obtaining a blood test to check the total serum bilirubin level. Though the blood test is considered most accurate, in certain instances, a transcutaneous bilirubin reading can be taken by placing a handheld sensor against the infant’s skin. If this reading is high, a blood test may be administered to confirm the total bilirubin level. Bilirubin levels are usually highest at 3rd to 5th day of the life.

Prognosis of Jaundice

Generally speaking, the prognosis for newborns with Jaundice is excellent if they receive the appropriate observation and treatment, and the vast majority of infants with neonatal Jaundice will get better with no adverse effects. However, health care professionals need to be vigilant and parents need be educated about the severe dangers of hyperbilirubinemia.