What Causes Jaundice In Newborns?

By:    Published: August 15, 2012

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Jaundice is a common occurrence in newborn babies, effecting approximately 60 percent of all babies born. Newborns that have jaundice have a yellowish appearance to their skin. Most newborns will require little intervention for jaundice, while others may have a more severe case that requires treatment.

What Is Jaundice?

Jaundice is characterized as a build-up of bilirubin in the newborn’s blood. Bilirubin is a component of red blood cells. Jaundice is seen regularly in newborn babies. For babies with jaundice, the skin and whites of the eyes appear to look yellow. This yellow discoloration may appear as early as 1 to 2 days after birth or as late as 3 to 5 days after birth, when bilirubin levels tend to be at their highest.

What Causes Jaundice In Newborns?

The most common type of jaundice, physiological jaundice, is caused by an excess of bilirubin accumulating in the blood. This type of jaundice is considered normal for newborns. Bilirubin is a byproduct that is left over when red blood cells are broken down. Bilirubin is then processed by the liver and excreted into the intestinal tract to be released from the body through bowel movements.

  • Physiologic jaundice occurs because a baby’s liver is not yet mature enough to keep up with the processing of the bilirubin, thus causing a build up in the blood which discolors the child’s skin and whites of the eyes.
  • This common type of jaundice is seen in both formula fed and breastfed babies and usually resolves within two to four weeks.
  • Jaundice can also be caused by other factors such as blood type incompatibility including Rh or ABO.
  • If the newborn and the mother have different blood types, it can result in the formation of antibodies in the mother’s blood that will attack the baby’s blood, thereby increasing the breakdown of red blood cells which leads to the development of jaundice.
  • Other causes of jaundice include an infection of the blood, harsh bruising that occurs during the birth, certain types of digestive disorders and liver malfunction.

Risk Factors

There are certain risk factors associated with jaundice including prematurity and breastfeeding.

  • Premature babies are less likely to be ready to eliminate bilirubin from their bodies since their liver may be less mature than a typical newborn.
  • In addition, premature babies sometimes feed less often than full term infants, which leads to decreased bowel movements. Because bilirubin is eliminated from the body via bowel movements, having less of them can lead to a build-up of bilirubin in the child’s blood, thereby causing jaundice.
  • Although it is the preferred method of feeding for both preterm and full term infants, breastfeeding is considered a risk factor because it is more difficult to determine how much milk a newborn has ingested. Although pediatricians recommend breastfeeding for preterm infants, a common concern is that if the baby is not taking in enough calories from the breast milk or not nursing properly, jaundice can develop.
  • Approximately 2 percent of breastfed babies, both preterm and full term, develop jaundice from certain components of their mother’s breast milk that cause bilirubin levels to rise.

Jaundice Symptoms

Jaundice symptoms usually begin to appear sometime between the first day to the fifth day of life.

  • Initially, your baby may appear to have a yellowish tint to his or her skin, eyes or both.
  • This discoloration generally appears first on the head and face and may gradually travel to the chest, legs and arms, then the whites of the eyes as the condition progresses.
  • Typically, a baby with jaundice is awake and alert, but in severe cases, the newborn will seem lethargic, ill or will cry often.

Contact the doctor immediately if the baby exhibits any signs or symptoms of jaundice.

Diagnosis

Your baby’s jaundice will most likely be suspected by the doctor during a routine examination when looking at his or her appearance.  If the baby’s skin or whites of the eyes are yellow in color, jaundice is likely.  If jaundice is suspected, your doctor will order a simple blood test to determine the actual level of bilirubin in the newborn’s blood. The severity of the child’s jaundice can then be determined in order to determine whether or not your baby will require treatment to resolve the jaundice. Babies with low levels of bilirubin in the blood will likely require no treatment.

Treatment

Babies with mild to moderate jaundice will likely require no treatment as the jaundice will generally resolve on its own within a week or two. The doctor may advise you to increase feedings for baby during this time to help flush out the bilirubin through bowel movements. Newborns with moderate to severe jaundice will require some intervention to help resolve their jaundice.

  • The most common form of treatment is phototherapy. During phototherapy, the baby is placed in an incubator where he/she will be exposed to a special light. This light has a direct effect on the bilirubin and makes it more easily excreted from the baby’s body through urine and bowel movements. During this treatment your baby will wear only a diaper and a protective eye patch. 
  • For jaundice that occurs as the result of a difference of blood type between mother and baby, an intravenous transfusion of immunoglobulin may be required. This protein will be injected into the baby so as to combat the antibodies from the mother’s blood that are destroying the baby’s red blood cells. This type of treatment will help resolve the jaundice and decrease the chance of the baby needing a full blood transfusion.
  • In rare cases when jaundice does not respond to any other treatment an exchange blood transfusion may be necessary. During this process, the baby’s blood is removed in small increments. The blood then undergoes a special treatment to rid it of bilirubin. It is then transferred back to the baby.

Possible Complications

If jaundice goes untreated, severe complications may arise. There are two major complications of untreated jaundice: acute bilirubin encephalopathy and kernicterus.

  • Acute bilirubin encephalopathy occurs when severe jaundice goes untreated and bilirubin invades the brain. Symptoms of acute bilirubin encephalopathy include fever, vomiting, arching back of the neck and body, high pitched crying and lethargy. Prompt treatment of acute bilirubin encephalopathy is necessary to prevent permanent brain damage.
  • Kernicterus is the condition that results when acute bilirubin encephalopathy is not resolved, resulting in permanent brain damage.  Characteristics of children with kernicterus include, uncontrolled or involuntary movements, eyes gazing upward, deafness and various intellectual impairments.

Jaundice in newborns is a generally a common, treatable condition. In most circumstances, provided that there is no underlying medical condition affecting the baby’s ability to rid the body of bilirubin, the condition will come and go with no long term effects. In most cases the newborn’s jaundice will resolve on its own with little or no treatment. Be sure your newborn’s blood is tested if you suspect he/she has jaundice.If you notice a yellow discoloration of the baby’s skin or eyes notify your doctor promptly.

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