DEFINITION

NEONATAL JAUNDICE

Jaundice in newborn babies is common and usually harmless. It causes yellowing of the skin and the
whites of the eyes. The medical term for jaundice in babies is neonatal jaundice. Yellowing of the skin
can be more difficult to see in brown or black skin.

Jaundice is the most common condition that requires medical attention and hospital readmission in
newborns. [89] The yellow coloration of the skin and sclera in newborns with jaundice is the result of
accumulation of unconjugated bilirubin. In most infants, unconjugated hyperbilirubinemia reflects a
normal transitional phenomenon.

CAUSES

A blood infection (sepsis).Neonatal sepsis can be caused by bacteria such as Escherichia coli (E coli),
Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of
neonatal sepsis. However, this problem has become less common because women are screened during
pregnancy.

A newborn who has an infection and develops sepsis can have inflammation throughout their body. This
inflammation and blood clotting causes reduced blood flow to your baby's limbs and vital organs. It can
lead to organ failure and even death.

A different blood type than you.

Bruising from a difficult birth.

Too many red blood cells.

A low oxygen level (hypoxia).

A liver condition such as biliary atresia.

Jaundice happens when your baby’s blood has too much bilirubin. Bilirubin is a chemical your body
makes when it breaks down old red blood cells. Your liver normally filters bilirubin from your blood. Your
body gets rid of it when you poop.

If your baby’s liver hasn’t developed enough to get rid of bilirubin, it can start to build up. This buildup of
bilirubin causes your baby’s skin to look yellow. Most babies develop jaundice in their first few days of
life. This is because it takes a few days for your baby's liver to develop and get better at removing
bilirubin.
SIGNS AND SYMPTOMS

Your baby's skin becomes more yellow.

The skin on your baby's the abdomen, arms or legs looks yellow.

The whites of your baby's eyes look yellow.

Your baby seems listless or sick or is difficult to awaken.

Your baby isn't gaining weight or is feeding poorly.

Your baby makes high-pitched cries. Jaundice is a condition in which the skin, whites of the eyes and
mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment.

Fever.

Chills.

Abdominal pain.

Flu-like symptoms.

Change in skin color.

Dark-colored urine and/or clay-colored stool.

MEDICAL INTERVENTION

Phototherapy. Phototherapy is treatment with a special type of light (not sunlight). It's sometimes used
to treat newborn jaundice by making it easier for your baby's liver to break down and remove the
bilirubin from your baby's blood. Phototherapy aims to expose your baby's skin to as much light as
possible.

Treatment for jaundice in newborns isn’t usually necessary. Mild levels of jaundice typically go away on
their own as your baby’s liver continues to develop. This can take one to two weeks. Feeding your baby
often (10 to 12 times a day) can encourage pooping (bowel movements). This helps your baby rid their
body of the excess bilirubin.

If your baby’s bilirubin level is high or continues to rise, their healthcare provider may recommend
phototherapy treatment. During phototherapy, your baby will be undressed and placed under special
blue lights. They’ll wear only a diaper and a mask to protect their eyes. Phototherapy helps your baby’s
liver get rid of excess bilirubin. The lights won’t harm your baby. Phototherapy treatment takes one to
two days. If your baby’s bilirubin levels aren’t too high, you may be able to treat your baby with light
therapy at home.
DIAGNOSIS EXAM

Physical Exam

Bilirubin > 5 mg/dL

Milder jaundice - face & upper thorax

Caudal progression generaly signifies higher bilirubine levels

Should not rely on this system

Liberally check bilirubin values

Laboratory

Blood

Transcutaneous

Generally within 2mg/dL of serum test

Most useful if serum bili < 15

The physical examination should focus on identifying one of the known causes of pathologic jaundice.
The infant should be assessed for pallor, petechiae, extravasated blood, excessive bruising,
hepatosplenomegaly, weight loss, and evidence of dehydration

Diagnostic procedures for hyperbilirubinemia may include: Direct and indirect bilirubin levels. A blood
test can determine if the bilirubin is bound with other substances by the liver so that it can be excreted
(direct), or is circulating in the blood circulation (indirect).

NURSING INTERVENTION

Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe
jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital.

Treatments to lower the level of bilirubin in your baby's blood may include:

Enhanced nutrition. To prevent weight loss, your doctor may recommend more-frequent feeding or
supplementation to ensure that your baby receives adequate nutrition.

Light therapy (phototherapy). Your baby may be placed under a special lamp that emits light in the blue-
green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they
can be excreted in both the urine and stool. During treatment, your baby will wear only a diaper and
protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or
mattress.
Intravenous immunoglobulin (IVIg). Jaundice may be related to blood type differences between mother
and baby. This condition results in the baby carrying antibodies from the mother that contribute to the
rapid breakdown of the baby's red blood cells. Intravenous transfusion of an immunoglobulin — a blood
protein that can reduce levels of antibodies — may decrease jaundice and lessen the need for an
exchange transfusion, although results are not conclusive.

Exchange transfusion. Rarely, when severe jaundice doesn't respond to other treatments, a baby may
need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood
and replacing it with donor blood, thereby diluting the bilirubin and maternal antibodies — a procedure
that's performed in a newborn intensive care unit.

Lifestyle and home remedies

When infant jaundice isn't severe, your doctor may recommend changes in feeding habits that can lower
levels of bilirubin. Talk to your doctor if you have any questions or concerns about how much or how
often your baby is feeding or if you're having trouble breast-feeding. The following steps may lessen
jaundice:

More-frequent feedings. Feeding more frequently will provide your baby with more milk and cause
more bowel movements, increasing the amount of bilirubin eliminated in your baby's stool. Breast-fed
infants should have eight to 12 feedings a day for the first several days of life. Formula-fed infants
usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the
first week.

Supplemental feedings. If your baby is having trouble breast-feeding, is losing weight, or is dehydrated,
your doctor may suggest giving your baby formula or expressed milk to supplement breast-feeding. In
some cases, your doctor may recommend using formula alone for a couple of days and then resuming
breast-feeding. Ask your doctor what feeding options are right for your baby.