JAUNDICE IN NEWBORN

Jaundice is a yellow discoloration of the skin and the white part (the sclera) of

the eyes. It results from having too much of a substance called bilirubin in the

blood.

 Bilirubin is formed when the body breaks down old red blood cells. The liver

usually processes and removes the bilirubin from the blood

As a baby's bilirubin levels rise, jaundice moves from the head to involve the arms,
trunk, and finally the legs. If the bilirubin levels are very high, a baby will appear
jaundiced below the knees and over the palms of his or her hands. One easy way to
check for jaundice is to press a finger against your baby's skin, temporarily pushing
the blood out of it. Normal skin will turn white when you do this, but jaundiced skin
will stay yellow

What Causes Newborn Jaundice?

Jaundice in newborns most commonly occurs because their livers are not mature
enough to remove bilirubin from the blood. Jaundice may also be caused by a number
of other medical conditions.

 Physiologic jaundice is the most common form of newborn jaundice. The

baby's liver plays the most important part in bilirubin breakdown. The type of

bilirubin that causes the yellow discoloration of jaundice is called unconjugated

or indirect bilirubin. This form of bilirubin is not easily removed from the

baby's body. The baby's liver changes this unconjugated bilirubin into

conjugated or direct bilirubin, which is easier to excrete. The liver of a newborn

 baby is immature, so the job of conjugating and removing bilirubin is not done

completely well. This causes an elevation of bilirubin, which results in the

yellow discoloration of the baby's eyes skin. As the breakdown of red blood

cells slows down, and the baby's liver matures, the jaundice rapidly disappears.

When jaundice is due to these factors alone, it is called physiologic jaundice.

 Neonatal jaundice can be seen in cases of maternal-fetal blood type

incompatibility. The mother's body will actually produce antibodies that attack

the fetus's blood cells. This causes a breakdown of the red blood cells and thus

an increased release of bilirubin from the red cells.

 Healthy red blood cells can be destroyed in a condition called HEMOLYSIS

 Polycythemia is a condition in which a child is born with an excess of red

blood cells.

 A large scalp bruise called a cephalohematoma can occur during the birthing

process. Such a bruise is really a collection of clotted blood just beneath the

skin surface. As the body naturally breaks down this clotted blood, a large

amount of bilirubin is released at once. This sudden excess in serum bilirubin

may be too much for the baby's liver to handle, and jaundice will develop.

 Sometimes a baby swallows blood during birth. This swallowed blood is

broken down in the baby's intestines and absorbed into the bloodstream. Just as

the excess blood from a blood clot will cause a rise in serum bilirubin, so will

this.

 A mother who has diabetes may cause a baby to develop neonatal jaundice.

 Crigler-Najjar syndrome (is a severe and rare genetic condition

characterized by high levels of toxic substance called bilirubin in the

 blood-hyperbilirubinemia) and Lucey-Driscoll syndrome are also conditions

that can cause jaundice

How Is Newborn Jaundice Treated?

 Significant jaundice is often treated with phototherapy. This involves placing

the baby on a warmer beneath special lights.

o These lights are able to penetrate a baby's skin and affect the bilirubin

within the child. The light changes bilirubin into lumirubin, which is

easily handled by the baby's body.

o This treatment may seem much like a visit to a local tanning booth.

Special goggles or a shade is placed over the baby's eyes to shield them

from the lights.

 Two factors help decide whether or not to start phototherapy: the age of the

child and the level of bilirubin.

o Younger children with higher bilirubin levels will more often require

treatment.
o The decision to begin phototherapy depends on the opinion of your

pediatrician and on your comfort level.

 If standard phototherapy doesn't work to reduce a baby's bilirubin level, the

doctor may try other treatments. For example, the baby may be placed on a

fiber optic blanket and an additional bank of lights may be added.

 If these treatments don't work, babies most often have a serious condition that

is causing their jaundice. Physiologic jaundice (the most common form) almost

never requires treatment beyond phototherapy.

 When all other treatments have failed to reduce the bilirubin level enough, the

last resort is an exchange transfusion. In this treatment, the baby's blood is

exchanged with donated blood. This is a very specialized procedure and is done

only in facilities capable of caring for critically ill children