What Is Infant Jaundice? What Causes Infant Jaundice?
Infant jaundice, also known as physiological jaundice, is a condition in which the skin, and sometimes the sclerae (the white part of the eye), of the baby appear yellow.
The color of the skin and sclerae varies depending on levels of bilirubin in the bloodstream. Bilirubin (bil-ih-ROO-bin) is the substance that causes yellowing of the skin and sclerae. When the liver is not completely developed it does not function properly, which results in bilirubinhyperbilirubinemia (excess of bilirubin).
During pregnancy the fetus’ blood bilirubin is removed by the mother’s liver.
According to MediLexicon’s medical dictionary, physiological jaundice is “A form of jaundice observed frequently in newborn infants in the first 1-2 weeks of life. It is caused by several factors, including a comparatively high red blood cell mass at birth compared with that of adults, shorter red blood cell lifespan, transiently impaired conjugation of bilirubin in the liver, and lack of gut flora (which are helpful in intestinal metabolism and excretion of bilirubin); is related to indirect (unconjugated) bilirubinemia that peaks at 2-3 days of age in normal, full-term infants and later with higher levels in preterm infants and is accentuated in breast-fed infants.”
Jaundice is a common condition in infants, affecting over 50% of all newborns, particularly premature babies – boys more often than girls. It usually appears within the baby’s first week of life.
Infant jaundice is rarely a cause for alarm, as it tends to go away on its own. However, if treatment is necessary infants tend to respond to noninvasive therapy. In rare cases untreated infant jaundice may lead to brain damage and even death.
What causes infant jaundice?
Infant jaundice is most often caused by an excess of bilirubin. Bilirubin is the waste that remains after hemoglobin (the predominant protein in red blood cells) is released from the breakdown of the red blood cells that carry oxygen throughout the body.
The hemoglobin of the red blood cells in the womb is different from the hemoglobin after birth. Therefore, the rate at which newborn babies’ bodies break down pre-birth red blood cells and produce new ones is very quick. This generates higher than normal levels of bilirubin that must be filtered out of the bloodstream by the liver and sent to the kidneys for excretion. However, an underdeveloped liver cannot filter out the bilirubin as fast as it is being produced, resulting in hyperbilirubinemia.
In some cases of infant jaundice, there may one of several underlying disorders. Some of these include:
- Liver disease.
- Sepsis – a blood infection.
- An abnormality of the baby’s red blood cells.
- Blocked bile duct or bowel.
- Rhesus incompatibility – when the mother and baby have different blood types, the mother’s antibodies attack the baby’s red blood cells.
- Enzyme deficiency.
- Bacterial or viral infections.
- Hypothyroidism – underactive thyroid gland.
- Hepatitis – an inflammation of the liver.
What are the risk factors for infant jaundice?
A risk factor is something that increases the likelihood of developing a disease or condition. For example, smoking raises the risk of developing many cancers – therefore, smoking is a risk factor for cancer.
Common risk factors for infant jaundice are:
- Premature birth – premature babies have severely underdeveloped livers and fewer bowel movements, which cause slow filtering and infrequent excretion of bilirubin.
- Breastfeeding – babies who do not get enough nutrients or calories from breast milk or become dehydrated are more likely to develop jaundice.
- Rhesus incompatibility – when the mother and baby have different blood types the mother’s antibodies permeate the placenta and attack the red blood cells of the fetus, causing accelerated break down.
- Bruising during birth – makes red blood cells break down faster, resulting in higher levels of bilirubin.
What are the signs and symptoms of infant jaundice?
The most pervasive sign of infant jaundice is yellow skin and sclerae (the whites of the eyes). This typically starts at the head, and spreads to the chest, stomach, arms and legs.
Other symptoms of infant jaundice include:
- Drowsiness
- Itchy skin
- Pale stools – breastfed babies should have greenish-yellow stools, while those of bottle fed babies should be a greenish-mustard color.
- Poor sucking/feeding
- Dark urine – a newborn’s urine should be colorless
Signs and symptoms of severe infant jaundice include:
- Yellow abdomen or limbs
- Drowsiness
- Yellow sclerae (whites of the eyes)
- Inability to gain weight
- Poor feeding
- Jaundice that lasts over three weeks
How is infant jaundice diagnosed?
Doctors recommend that babies be tested for jaundice before being discharged from the hospital and again three to five days after birth, when bilirubin levels are highest.
There is a test you can perform yourself to see if the infant has jaundice, although it is not conclusive. Normally, when you press your finger on skin the pressed area is slightly lighter than the normal skin color.
However, if the area where you pressed your finger looks yellow, chances are the infant has jaundice. This test is best performed under natural daylight.
Doctors will most likely diagnose jaundice based on appearance alone. However, the severity of jaundice will be determined by measuring levels of bilirubin in the blood. Bilirubin levels can be checked via a serum bilirubin (SBR) blood test or a transcutaneous bilirubinometer device, which measures how much of a special light shines through the skin.
If the infant’s jaundice persists for over two weeks doctors may perform further blood tests and urine tests to check for underlying disorders.
What are the treatment options for infant jaundice?
Typically, treatment for mild jaundice in infants is unnecessary, as it tends to disappear on its own within two weeks.
If the infant has severe jaundice they may need to be readmitted to the hospital for treatment to lower levels of bilirubin in the bloodstream.
Some treatment options for severe jaundice include:
- Phototherapy (light therapy) – treatment by light rays. The baby is put under a special light, covered by a plastic shield to filter out ultraviolet light, that manipulates the structure of bilirubin molecules so they can be excreted; sometimes it is useful to use a light-emitting mattress under the baby as well. Usually the baby is naked, wearing only protective eye patches.
- Exchange blood transfusion – the baby’s blood is repeatedly withdrawn to filter out bilirubin and then transferred back into the bloodstream. This procedure will only be considered if phototherapy does not work because the baby would need to be in an intensive care unit (ICU) for newborns.
- Intravenous immunoglobulin (IVIg) – if there is a difference in blood type, the infant can get a transfusion of immunoglobulin, a protein in the blood that can lower levels of any remaining antibodies from the mother, which may be attacking the infant’s red blood cells.
If jaundice is caused by something else, surgery or drug treatment may be required.
What complications could occur from infant jaundice?
- Acute bilirubin encephalopathy – a condition caused by a buildup of bilirubin in the brain (bilirubin is toxic to brain cells). Signs of acute bilirubin encephalopathy in a baby with jaundice include fever, sluggishness, high-pitched crying, poor feeding, and arching of the body or neck. Immediate treatment may prevent further damage.
- Kernicterus (nuclear jaundice) – a potentially fatal syndrome that occurs if acute bilirubin encephalopathy causes permanent brain damage.
How can infant jaundice be prevented?
The best way of reduce chances of an infant developing jaundice is to make sure they are well fed. For the first week or so of life, breastfed babies should be fed eight to twelve times a day, while formula-fed babies should be fed one to two ounces of formula every two or three hours.
Written by Caroline Gillott
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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