Neonatal Jaundice

Neonatal Jaundice - What it is

Neonatal Jaundice (NNJ is a yellow discolouration of the skin and the whites of the eyes. Mild jaundice is quite common in newborn period and is usually a temporary condition that causes no problems in the vast majority of babies.

Neonatal Jaundice - Symptoms

The yellow colour of the skin is the main symptom of jaundice usually beginning on the baby’s face and moving down to the chest, abdomen, legs and finally to the palms of the hands and soles of the feet. The discolouration is also seen in the whites of the eyes. Sleepiness and poor feeding may also be present in infants who have significant jaundice

Neonatal Jaundice - How to prevent?

Jaundice is a common condition in newborns and it cannot be prevented. It is important to ensure good fluid intake for all newborn babies. Jaundice is often exaggerated with mild dehydration. Mild jaundice in the first week needs no treatment except attention to hydration. One can prevent jaundice levels reaching very high by timely phototherapy and treatment of any risk factors (e.g. infection, Blood group incompatibility etc.)

Neonatal Jaundice - Causes and Risk Factors

In the human body, new blood is being made all the time and old blood is being destroyed. One of the products of destroyed blood is called bilirubin. Bilirubin normally goes to the liver to be processed and then leaves the body in the faeces. For the first few days after birth there tends to be a build-up of bilirubin in the blood because of immaturity of the liver. This causes the yellow colour in the skin and whites of the eyes.

Risk Factors

Prematurity
Poor feeding
Bruising at birth
Infection
G6PD Deficiency ( common in Singapore)
ABO and Rhesus incompatibility
Underlying liver disease
Hypothyroidism

Neonatal Jaundice - Diagnosis

A blood test to measure the level of bilirubin in the baby’s blood, called serum bilirubin level (SBR), may be ordered. This is the most accurate way to measure an SBR and involves collecting a small amount of blood from the hand or via a heel prick.

Additional blood tests or urine tests may also be ordered if there is evidence that the baby’s jaundice is caused by an underlying disorder that will need treatment or if the jaundice is still evident 2-3 weeks after birth (Prolonged Jaundice).

Neonatal Jaundice - Treatments

Moderate jaundice is treated by placing a baby naked (with a protective mask over the eyes) under a bright ultraviolet light source. This is called phototherapy and can be delivered safely in many different ways. The number of lights is proportional to the levels of bilirubin.

The light breaks down the bilirubin in the skin and makes the jaundice fade. Unsupervised exposure to direct sunlight is not recommended, as it can be harmful causing sunburn.

Occasionally, if jaundice is due to excessive breakdown of red cells (e.g. blood group incompatibility) and leads to severe jaundice a baby may need to have a special blood transfusion in which the baby's blood is replaced (exchanged) with fresh blood to wash the bilirubin out of the system. A blood product ( Immunoglobulin) may also be infused to try and prevent the baby’s red cells from being coated with by maternal proteins ( antigens) and destroyed by a different group of cells in the baby’s blood ( macrophages), a process known as haemolysis.

Severe jaundice is a medical emergency and may lead to long term neurological complications form passage of bilirubin into the baby’s brain. Hence the need to manage with multiple phototherapy, immunoglobulin or exchange transfusion.

Overview

Cerebral Palsy ＆ Motor Disorders,

Hypothyroidism

Article contributed by Neonatal ＆ Developmental Medicine, Singapore General Hospital

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