Overview
Infant jaundice is a common condition in newborn babies, characterized by the yellow discoloration of the skin and eyes due to an excess of bilirubin in the bloodstream. Bilirubin is a yellow pigment of red blood cells that the baby's immature liver is unable to remove quickly enough, leading to the buildup of this pigment. Infant jaundice can occur in babies born prematurely or in some breast-fed babies. Most babies born between 35 weeks' gestation and full term do not require treatment, but those with high bilirubin levels or specific risk factors may need medical attention to prevent complications like brain damage.
Understanding the disease
Symptoms
The symptoms of infant jaundice include yellow discoloration of the skin and eyes, which usually appear between the second and fourth day after birth. The skin and whites of the eyes may look yellow where pressed gently. Infants with jaundice may also appear more sleepy or irritable than usual. The condition is typically harmless and resolves on its own within a few weeks, but it's essential to monitor the baby and seek medical attention if there are signs of severe jaundice or complications, such as excessive sleepiness, poor feeding, or abdominal swelling.
Risk Factors
Risk factors for developing infant jaundice include premature birth and significant bruising during birth, which may lead to higher levels of bilirubin from the breakdown of more red blood cells. Other risk factors include having a different blood type between the mother and baby, breast-feeding difficulties, East Asian ancestry, and underlying disorders such as internal bleeding, infection, liver malfunction, biliary atresia, enzyme deficiency, or abnormalities in red blood cells.
Development
Infant jaundice develops when there is an excess of bilirubin (a yellow pigment of red blood cells) in the baby's bloodstream. This excess bilirubin is responsible for the yellow discoloration of the skin and eyes. The main cause of infant jaundice is excess bilirubin or hyperbilirubinemia. Newborns produce more bilirubin than adults because of their greater production and faster breakdown of red blood cells in the first few days of life. An immature liver often can't remove bilirubin quickly enough, leading to an excess of bilirubin. This form of jaundice is called physiologic jaundice and typically appears on the second or third day of life. In some cases, an underlying disorder may cause infant jaundice, leading to earlier or later onset. These underlying diseases or conditions can include internal bleeding, infections, or metabolic disorders. If there are risk factors present, such as significant bruising during birth or blood type incompatibility, the jaundice may indicate severe jaundice or complications from excess bilirubin. In such cases, it is essential to seek medical attention promptly.
Assessment and Diagnosis
Triage
You should see a doctor if infant jaundice is suspected when any of the following signs or symptoms are present:
- Yellowing of the skin and whites of the eyes
- Excessive sleepiness or lethargy
- Poor feeding or lack of interest in feeding
- High fever
- Abdominal or upper body swelling
- Dark urine and pale stools
- Floppy or stiff limbs
- Severe weight loss
- Jaundice that appears much earlier or much later than the second or third day of life
- Any other concerning symptoms or signs It's important to follow your healthcare provider's recommendations regarding routine check-ups and follow-up appointments after discharge. If you have any concerns about your baby's health, consult with your doctor for advice and guidance.
Diagnosis
Infant jaundice can be diagnosed based on the baby's appearance, as well as through laboratory tests of a sample of the baby's blood and a skin test using a device called a transcutaneous bilirubinometer. The doctor will assess the baby's bilirubin levels in the blood, feeding habits, age, and other factors such as premature birth or bruising from delivery to determine the severity of the jaundice. If there are underlying disorders, additional blood or urine tests may be ordered.
Management and Treatment
Complications
Complications of infant jaundice can arise due to high levels of bilirubin that cause severe jaundice. Some of the potential complications include:
- Acute bilirubin encephalopathy: This condition occurs when bilirubin, which is toxic to brain cells, passes into the baby's brain. Symptoms of acute bilirubin encephalopathy may include listlessness, difficulty waking, high-pitched crying, poor sucking or feeding, backward arching of the neck and body, and fever.
- Kernicterus: Kernicterus is a syndrome that results from permanent damage to the brain caused by acute bilirubin encephalopathy. It can lead to involuntary and uncontrolled movements (athetoid cerebral palsy), permanent upward gaze, hearing loss, and improper development of tooth enamel.
- Internal bleeding (hemorrhage): High bilirubin levels may cause blood vessels to burst, leading to internal bleeding.
- Infection in the baby's blood (sepsis): Sepsis is a severe bloodstream infection that can be caused by bacteria or viruses. Infants with severe jaundice have a higher risk of developing sepsis.
- Other viral or bacterial infections: Infants with severe jaundice may be more susceptible to other infections.
- Incompatibility between the mother's blood and the baby's blood: When the mother has an Rh-negative blood type and the baby has an Rh-positive blood type, it can lead to complications like hemolytic disease of the newborn.
- Liver malfunction: A liver malfunction can make it difficult for the baby's body to process and eliminate bilirubin.
- Biliary atresia: This condition occurs when the baby's bile ducts are blocked or scarred, affecting the liver's ability to process and eliminate bilirubin.
- Enzyme deficiency: Some babies may have a deficiency in an enzyme necessary for the proper processing of bilirubin, leading to
Prevention
Infant jaundice is a common condition, particularly in babies born before 38 weeks' gestation (preterm babies) and some breast-fed babies. The best way to prevent infant jaundice is through adequate feeding. Breast-fed infants should have eight to 12 feedings a day for the first several days of life, while formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week. This helps the baby's liver to develop properly and effectively process the excess bilirubin.
Home Remedies
It's important to consult with a healthcare professional for appropriate treatment and guidance regarding infant jaundice.
Treatment
The best preventive measure for infant jaundice is adequate feeding. Breast-fed infants should have eight to 12 feedings a day for the first several days of life, while formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital. Infants born between 35 weeks' gestation and full term usually don't require treatment for jaundice. However, if bilirubin levels are unusually high or there are other risk factors, treatment may be necessary. Treatment options may include:
- Phototherapy (also called fiber-optic phototherapy or bili-light therapy): This is the most common treatment for jaundice. The baby is placed under special blue light that helps to break down the excess bilirubin in the blood.
- Exchange transfusion: In rare cases where phototherapy isn't effective or the bilirubin levels are extremely high, an exchange transfusion may be performed. This involves removing some of the baby's blood, replacing it with donor blood that does not contain bilirubin, and then returning the baby's blood. It is important to monitor your baby for signs of severe jaundice or complications, such as yellowing of the eyes, lethargy, poor feeding, or abdominal distension. If you notice any of these symptoms, consult your doctor immediately.
Preparing for medical consultation
To prepare for an appointment for infant jaundice, you should:
- Find out if your child needs to follow any pre-appointment restrictions, such as changing food or liquid intake to get ready for blood and urine tests.
- Make a list of any signs and symptoms your child has been experiencing, and for how long.
- Make a list of your child's key medical information, including recent illnesses, any medical conditions, and the names and dosages of any medications, vitamins, herbs, or other supplements.
- Prepare questions to ask your healthcare provider. Some basic questions may include:
- What is likely causing my child's signs and symptoms?
- Are there other possible causes for these symptoms?
- What kinds of tests does my child need?
- What treatment approach do you recommend?
- What are the expected results of treatment?
- What are the possible side effects of treatment?
- How will you monitor my child's health over time?
- What is my child's risk of long-term complications? Remember to bring your child's medical records and any test results to the appointment. This information will help the healthcare provider make an accurate assessment and provide appropriate treatment recommendations.