Neonatal jaundice meaning is defined as an infant’s skin turning yellow during the first few days of life. The yellowish tint is caused by an abnormally high level of a blood pigment called Bilirubin, which settles in the skin. This is a common occurrence that occurs in approximately two-thirds of all healthy babies. It may, however, be a symptom of a problem with the baby’s nourishment, degree of hydration, or lifespan of red blood cells. Other uncommon causes of jaundice include metabolic problems, gland malfunction, or liver illness. Only the infant’s health care practitioner can evaluate whether or not the infant’s jaundice is normal and may order a blood test to aid in diagnosis. In some instances, a specialist in liver illness or blood abnormalities may be consulted to assist with the newborn’s treatment. Treatment options range from the simplest, such as boosting the baby’s water intake and changing the feeding schedule, to the most sophisticated. Treatment is determined by the degree of the jaundice, the source of the elevated bilirubin level, and the kind of bilirubin.
Neonatal jaundice may have been described for the first time in a Chinese textbook over a thousand years ago. Since the 18th and 19th centuries, medical theses, essays, and textbooks have been examining the causes and treatment of newborn jaundice.
Symptoms
The initial symptom is a yellowing of the skin and eyes. As early as the first or second day of life, the infant’s skin may appear yellow. Jaundice begins on the scalp and face and spreads to the shoulders, arms, and the rest of the body, including the legs and feet. When the baby is 3 to 4 days old, the appearance may grow more yellowish and then it gradually improve. This condition is referred to as “physiologic” or “normal” newborn jaundice. Because the majority of newborns exhibit this pattern, no testing is necessary.
Occasionally, the yellowish appearance may begin sooner (shortly after delivery), stay longer than 5-6 days, or be much more apparent. Following that, a meeting with your health care practitioner is required to establish whether testing is necessary.
Along with the yellowing of the skin, the baby’s urine may change color from very light yellow to extremely dark brown. Similarly, the color of the baby’s stool might range from yellow mustard to light beige. These two differences in the color of the urine or stool may indicate that the jaundice is caused by separate pigments. Although extremely rare in the earliest days of life, extremely black urine or light beige stool should be investigated immediately by a physician.
Causes
The neonatal jaundice causes may be determined as follows:
The yellow color is caused by an excess of a yellow pigment called bilirubin in the skin. Immediately upon birth, the infant’s body must degrade the red blood cells produced while in the womb and regenerate new ones now that the newborn is breathing ambient air. The blood’s red color is due to a protein called hemoglobin, which transports oxygen. As cells degrade, hemoglobin is changed in the liver to form bilirubin. Due to the infant’s undeveloped liver, it cannot keep up with the amount of bilirubin generated, which then leaks into the bloodstream and deposits on the skin.
Treatment
The neonatal jaundice treatment is determined by the etiology of the jaundice and the level of bilirubin. For the sake of this article, we shall describe exclusively the therapy of unconjugated or indirect bilirubin increase. We will not discuss jaundice related with liver disease or rare conditions that result in an increase in the pigment bilirubin, either conjugated or direct.
Typically, typical physiological newborn jaundice is self-limiting, and the infant does not require treatment. Unconjugated bilirubin is degraded simply by exposure to indirect sunshine. This is far and away the majority. The newborn may be able to be discharged from the nursery without incident within the first 48 hours of life. The pediatrician will need to monitor the baby’s bilirubin level and weight to ensure that it is normal. This is particularly true for breastfed infants.
If the level of unconjugated or indirect bilirubin remains elevated or increases, the newborn may require additional treatment to reduce the bilirubin level. Among the possible treatments are the following:
- Certain infants may have a high indirect bilirubin level as a result of breastfeeding. Breastfeeding for 48 hours and supplementing with infant formula may help reduce bilirubin levels in certain babies with “breast feeding jaundice.” After 10-14 days, a small percentage of breastfed infants may continue to have increased indirect bilirubin. Again, withholding breastfeeding for two or three days may be sufficient, and breastfeeding can resume once the indirect bilirubin level has decreased. Breastfeeding is by far the greatest option for neonates and should not be discontinued abruptly due to a slight increase in unconjugated or indirect bilirubin. Families should consult their physician or health care provider to determine whether or not it is appropriate to discontinue breastfeeding and for guidance on how to proceed.
- Phototherapy is a procedure that uses a specific light to break down the bilirubin beneath the skin. Typically, these lights are blue-green in color. They are positioned around 4 inches above the infant. The more skin exposed to the lights, the more effectively they break down unconjugated or indirect bilirubin. The lights have no effect on the baby’s ability to sip formula or breastfeed. At feeding times, the baby can be safely removed from the phototherapy without impairing the treatment’s efficacy. Generally, phototherapy poses no substantial dangers. The baby’s eyes will be shielded to protect them from the harmful effects of light. There are no hazards to the baby’s genitals. As long as the bilirubin level is not excessive, phototherapy can be performed at home using a special blanket called a “bili” blanket. Then, the physicians will arrange for regular blood tests to confirm that the medication is effective. The majority of insurance companies will cover this type of treatment at home.
- Unconjugated or indirect bilirubin levels in a few babies are so high (more than 20-25 mg/dl) that physicians are concerned about brain damage. The level must be rapidly reduced using a process known as exchange transfusion. In the newborn intensive care unit, an exchange transfusion is administered. The baby’s blood is swapped and gradually replaced with that of a donor. This enables the indirect bilirubin to be eliminated more rapidly, hence reducing the chance of future problems. This treatment is intended for the most severe cases of kernicterus (a condition where the indirect bilirubin is stored in areas of the brain and causes abnormal movements and seizures.)
Jaundice is the most prevalent complication requiring medical treatment and hospital readmission among infants. The yellowing of the skin and sclera of babies with jaundice is caused by the buildup of unconjugated bilirubin. Unconjugated hyperbilirubinemia is a normal transitory state in the majority of babies. However, in certain infants, blood bilirubin levels may increase abnormally high, which is cause for concern because unconjugated bilirubin is poisonous and can result in newborn mortality or lifelong neurologic sequelae in survivors (kernicterus). As a result of these factors, newborn jaundice frequently necessitates diagnostic assessment.
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