Infant Jaundice or Neonatal Jaundice

What is Jaundice in infants? What is infant jaundice? 

Infant jaundice or neonatal jaundice is the yellowish discoloration of the skin, scleral part of eyes, inside of mouth, etc. due to the excess build up of the yellow pigment called bilirubin in the blood.

The doctors say it Neonatal jaundice, means the jaundice that appears in the newborn babies(also called neonates).  

Jaundice in the neonates and infants is a common physiological disorder as it is a result of rbc breakdown which produces bilirubin.  The destruction and production of red blood cells is fast in the infants and their liver is comparatively immature to handle the overload.  Due to this reason, the bilirubin gets collected more in the blood of babies making them appear yellowish. 

Yellow color of the skin and eyes is a result of high bilirubin levels in the blood of the babies.

It is normal in babies and may start appearing within 72 hours. Your baby's doctor will examine your baby for physiological jaundice. 

What are the features or characteristic symptoms of jaundice in babies? Why do newborn babies have jaundice ? 

It is the most common question arising in the minds of the parents. But there are certain features of jaundice in newborns and infants. Let us find out why?

1. It is a physiological disorder commonly seen in the neonates or newborn babies. Liver in babies is immature to process the bilirubin in the blood and so bilirubin is not excreted normally. 
2. It makes your baby's skin and eyes look yellowish.  If your baby is dark-skinned or brown-skinned, it may be difficult to identify and diagnose it earlier.  However, looking at the eyes in sunlight or good light may help you identify the condition.
3. It is not necessary that all babies will have jaundice. 
4. It usually does not require medical treatment.  Breastfeeding 8-10 feeds helps a lot in resolving the jaundice symptoms.  
5. It may need a phototherapy or blood transfusion therapy in some babies whose symptoms do not go away easily. 
6. If it is not a physiologic jaundice, it would be a matter of concern and you need to see your baby's doctor right away.  Your baby's jaundice still appears after a week then it is a more severe problem and your doctor would need to do further diagnostic tests to identify any underlying medical condition such as biliary duct atresia or scarring. 
7. See your doctor immediately if you feel your baby is getting sick or does not respond to any stimulus actively.  

What are the causes of jaundice in infants?

Jaundice in infants or neonatal jaundice appears as a common physiological change after birth.  It is not a matter of concern usually.  Although not all babies born have jaundice, there is a majority of those who develop jaundice from day 2 to day 4 of their life. 

The following causes may be responsible for jaundice in newborns or infants:

1. Premature or preterm babies: Babies born before term or 37 weeks are generally weak and their liver is immature more. So they may develop the signs of jaundice. 

2. Rh incompatibility or the rhesus factor in the blood:  When the negative blood group of the mother reacts with the positive fetus, it may produce anitbodies.  There is breakdown of the red blood cells in a large number. This may be the cause of bilirubin-buildup in the blood, thus causing jaundice. 

3. Genetic disorders: The babies born with genetic deficiency may have metabolic errors. This leads to the increase in the bilirubin causing jaundice. 

4. Poorly breastfed babies: If the baby is not breastfeed properly there may be dehydration and the fluid needed for the removal of excess bilirubin may not be available. This can lead to the rise of bilirubin in the blood. 

5. Breastmilk: Some scholars believe there is a presence of some substances in the breastmilk that help increase the bilirubin. So the babies get jaundice. 

6. Structural or anatomical problems: The babies born with congenital disorders such as bile duct atresia may not have proper secretion and removal of the bilirubin into the intestines and urine. This may cause the levels of bilirubin in the blood to rise causing jaundice. 

What are the major symptoms of jaundice?

Jaundice in neonates and infants presents with the following major symptoms:

• Yellowish discoloration of the skin and eyes( the white portion called sclera).
• Dark-colored or yellow urine. 
• The stools are pale in color. 

Sometimes the chest, palms and foot also appear yellow due to the increase in the bilirubin than the previous day. 

This symptoms usually start from day 2nd to 4th and may continue upto a week or two. Appearance of jaundice before or after this duration may not be a normal thing and you need to talk to your doctor about this. 

What are the risk factors that can cause jaundice in infants?

• Preterm delivery
• Premature babies
• Rh incompatibitlity
• Infections
• Anatomical obstruction in the bile duct(congenital birth defects)
• Babies who are not breastfed effectively
• Babies who are born with genetic disorders. 

The premature babies tend to have more immature liver as compared to the babies born at term. This makes their liver less effective in excreting the bilirubin from the blood. 

Is infant jaundice treatable?

Infant or neonatal jaundice usually does not require treatment and the symptoms subside on its own within a week in most of the cases.  The only medical advice that may be given is:

• Initiate early breastfeeding and provide atleast 8-10 feedings a day to your baby. 
• Keep your baby hydrated by ensuring the baby gets proper feedings. 
• Your doctor may recommend noticing your baby for any signs of jaundice if you are sent home within 72 hours with your baby. 
• If you see any yellow tinge in the eyes and the skin of your baby and the urine color has become dark yellow, you need to call or visit your baby's doctor. 
• Many doctors would advice to give your baby a sunbath in the morning hours. For this, he may recommended keeping your baby in sunlight naked only with diaper and eyes closed with some eyepad.  Do not place your bbay in harsh sunlight. Remember it should be early morning hours when the sunlight is mild and gentle on the skin. 
• In some babies, the jaundice symptoms are severe or they go on becoming more yellowish till their body has turned yellow from head to toes.  Please do not wait for this. Immediately seek medical advice and get your baby treated. 

Jaundice in infants who have severe presentation can be treated by:

Call your doctor if you feel:

• Your baby is not taking feeds properly.
• Your baby cries high-pitched or remains fussy all the time.
• Your baby sleeps more or unusually
• Your baby looks fatigued or weak.
• Your baby has seizures or irritability. 

These may alarm some complications of jaundice or it may be jaundice due to some other medial cause. See your doctor without fail. 

The treatment in severe cases can be done in following ways:

Jaundice appearing within 24 hours of birth usually is not a normal phenomenon and it may require immediate medical intervention. 

Phototherapy or light therapy: 

• Phototherapy is the most effective treatment for jaundice in infants whose symptoms do not subside on its own. 
• The baby is placed on a specialised bed under the blue light source on a light emitting blanket underneath the body.
• The baby is put naked with eyepads on the eyes and diapers to cover the genitals. Eyepads protec the eyes from corneal dryness and irritation or any damage to the delicate eyes of the baby. Genitals are protected from the harmful rays by putting on diapers.  
• The light falls on the whole body and breaks down the bilirubin in the blood into a water soluble form or component which then easily gets excreted in the urine.  
• It is the effective method to treat jaundice in babies whose symptoms do not resolve on their own.
• The diaper may show yellow spots due to the excretion of the bilirubin in the urine of the baby and the parents need not to worry in this case. Their baby is getting rid of jaundice. 

Blood transfusion: 

• Some babies do not effectively respond to phototherapy or breastfeeding. They need immediate blood transfusion. 
• The blood transfusion is aimed at replacing the bilirubin containing blood with fresh exchange blood. It is called exchange transfusion and it helps restore the normal bilirubin and prevent any further complications in the babies.

Immunoglobulin treatment:

• It is given to the mother with negative blood group bearing a Rh positive fetus.
• It helps prevent the production of antibodies against the positive factor. 
• These antibodies may destroy or break down the red blood cells of the baby. Breakdown of red blood cells builds up bilirubin causing jaundice.
•  So the immunoglobin shots must be given to the pregnant lady 24 hours before and after birth to prevent releasing antibodies against the fetus or baby. 

Surgery: 

• Some defects may be rare like atresia of bile duct which block the bile flow. This increases the bilirubin levels due to bile obstruction. 
• However if the scan suggests the mechanical cause of jaundice then surgery may be recommended by your baby's doctor.

What are the complications of neonatal or infant jaundice?

If jaundice is left untreated it can cause a rare complication known as the kernicterus. It is the yellowish staining of the brain parenchyma. The build up of the bilirubin in the blood causes damage to the brain. This is known as kernicterus. It may be characterised by sudden seizures, hearing loss, loss of cognitive abilities and athethoid palsy, abnormal or poor teething and visual disturbances. 

Kernicterus is a very rare complications.  Most of the severe cases get treated promptly before getting complicated. 

What care must be taken if your baby have jaundice? 

• At home make sure you as a mother are the primary care taker of your baby.

Only a mother can easily notice any changes in her baby

• If you see any yellowish discoloration with 72 hours of life of your baby, see your doctor. It can be jaundice.   
• Breastfeed your baby nicely. Feed at least 8-10 feedings per day. It helps release out the excess bilirubin in urine.  
• If your baby is on formula, make sure you increase the formula feeds gradually.  It is necessary to keep your baby hydrated at all times. 
• Have your baby lie on your lap in a diaper while sitting under mild, gentle sunlight. Let your baby get sunbathed to remove out the excess bilirubin from the blood. 
• Notice the baby's feeding pattern and the skin changes, the symptoms must start subsiding on its own in few days. 
• At almost 3 weeks the liver becomes mature enough to metabolise the bilirubin. This is the reason most of the jaundice having babies do not need any medical treatment. 

Newborn or neonatal jaundice, also called infant jaundice is a common medical condition seen even in healthy babies. It is a matter of concern if it appears within or before 24 hours of birth of the newborn, It makes your baby's skin and eyes appear yellow, the urine becomes dark colored and the poo looks pale. It usually needs no treatment. Only severe cases need treatment to prevent complication such a kernicterus or brain damage.

Note: This post is for informational and educational purpose only, It is not a substitute to any medical or professional advice or treatment. See your doctor in any case.