What is jaundice?
Jaundice is yellow discoloration of a newborn baby's skin and eyes. Neonatal jaundice, also known as neonatal hyperbilirubinemia, is caused by an increase in the amount of a substance known as bilirubin, a by-product of the breakdown of red-blood cells. This is a normal physiological process that occurs after birth.
The baby’s skin may appear yellow as early as the first or second day of life.
The jaundice starts around the head and the face then progresses to the shoulders, arms, and the rest of the body (including the legs and feet). The appearance may become more yellow when the baby is 3 to 4 days old and then slowly gets better. This is called “physiologic” or normal neonatal jaundice. Most infants have this pattern, therefore, no testing is needed.
Fortunately, newborn jaundice goes away on its own as a baby’s liver develops-usually within 2 to 3 weeks. Jaundice that persists longer than 3 weeks may be a symptom of an underlying condition. This is referred to as pathological jaundice.
Causes of jaundice
As explained earlier, jaundice can be classified as physiological (which is normal and common in most newborns), or pathological which is caused by underlying diseases.
Physiological jaundice
Mild, transient, and self-limiting yellow discoloration that resolves without treatment referred to as "physiological jaundice.”
This is the most common cause of jaundice in newborn babies. After birth, the baby’s body must break down the red blood cells used while in the womb, and make new ones now that the baby breathes the ambient air. As cells are being broken down, the hemoglobin gets modified in the liver and becomes bilirubin. Because the baby’s liver is so young and immature, it cannot keep up with all the produced bilirubin, which then leaks into the blood stream and settles in the skin.
Pathological jaundice
Sometimes, jaundice may indicate an underlying disease or condition. Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day, or is higher than 17 mg per dL (290 mol per L), or a baby that has signs and symptoms suggestive of serious illness (outlined later).
Common causes for pathological jaundice are:
Internal bleeding (hemorrhage)
An infection in your baby's blood (sepsis)
Other viral or bacterial infections
An incompatibility between the mother's blood and the baby's blood (Rh Incompatibility)
A liver malfunction
Biliary atresia, a condition in which the baby’s bile ducts are blocked or scarred
An enzyme deficiency
An abnormality of your baby's red blood cells that causes them to break down rapidly
When to be concerned about jaundice?
Although jaundice is often a normal and treatable condition, sometimes jaundice can indicate an underlying medical condition. If not treated, it can lead to severe jaundice. High amount of bilirubin in the blood increases the risk of bilirubin passing into the brain, which can cause permanent brain damage.
You must look out for the following signs and symptoms and contact your doctor or other healthcare professional as soon as possible if your baby
has a stiff, limp, or floppy body;
has strange eye movements such as jittering (having seizures);
has yellow discoloration of the skin, mucous membranes, and the whites of the eyes, or when it gets darker;
has light-colored stool;
poor feeding;
is crying inconsolably or with a high pitch;
becomes arched like a bow (the head or neck and heels are bent backward and the body forward); and/or
develops a fever over 38°C.
When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. Kernicterus is a type of brain damage that results from high levels of bilirubin in a baby’s blood. It can cause athetoid cerebral palsy and hearing loss. Kernicterus is also known to causes problems with vision and teeth, and sometimes can cause intellectual disabilities.
Take home message
Jaundice is a common medical condition that occurs in newborn babies. It may be physiological or pathological. Seek immediate medical attention when you recognise any signs and symptoms.
This article is written by Dr. Itumeleng Buti (MBChB)
References
1. Gilmour SM. Prolonged neonatal jaundice: When to worry and what to do. Paediatrics & child health. 2004 Dec 1;9(10):700-4.
2. Ansong-Assoku, Betty, and Pratibha A. Ankola. "Neonatal jaundice." (2018).
3. Danielle Moores. Understanding Newborn Jaundice. [Internet] Heathline Media: [Updated 2017 July; Cited 2022 April 29] Available from: https://www.healthline.com/health/newborn-jaundice.
4. Mayo Clinic. Infant Jaundice. [Internet] [Updated 2022 January 6; Cited 2022 April 30] Available from: https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes.
5. BetterHealth Clinic. Jaundice in babies. [Internet] [ Updated 2019 July 21; Cited 2022 April 30] Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/jaundice-in-babies#where-to-get-help.
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