Jaundice In The Newborn Child
Jaundice in a newborn is one of the common conditions that need medical attention. Jaundice occurs due to increased levels of an orange-red pigment called bilirubin in the blood. As bilirubin begins to build up, it deposits on the fatty tissue of the skin, causing the skin and eyes to be stained yellow.
How do I recognise that my child has jaundice?
If your baby is jaundiced, his/her skin and eyes may appear yellow. It may be difficult to recognise jaundice in a dark skinned baby, and yellow eyes may be the only indication of jaundice. Many babies develop jaundice early in life, which most of the time clears up on its own without any medical intervention in 10 to14 days. This is often referred to as physiological jaundice.
Sometimes, jaundice, although not severe enough to cause problems, may persist well beyond 14 days and sometimes up to several weeks, especially in exclusively breastfed infants. This type of jaundice, referred to as breast milk jaundice, is harmless and needs no special intervention.
Occasionally, some babies may develop very high levels of bilirubin within the first week of life that need to be decreased quickly using medical interventions like phototherapy or very rarely an exchange transfusion/intravenous immunoglobulin infusion. The usual reasons for such high levels of bilirubin may include blood group incompatibility between the baby and the mother. Failure to treat severe jaundice in a timely fashion might lead to serious complications including deafness, convulsions and even death. Phototherapy refers to placing the baby under special ultraviolet lights that help speed up the breakdown process of bilirubin. This is a very effective noninvasive treatment with very few side effects. The baby is placed in a cot or incubator with eyes covered with a mask and lights placed 20 cm above the baby.
One needs to keep the baby well hydrated and the baby might experience a skin rash or a tan. Phototherapy may be given using single surface, double surface or even a fire optic blanket. These effective lights have virtually reduced the need
for exchange transfusions (a complete changeover of the baby’s blood). Exposing the newborn baby to natural sunlight is not proven to be useful in decreasing jaundice. This is not recommended as it may actually cause dehydration in a baby.
Learn a little more about bilirubin
Bilirubin is a pigment that is produced bythe breakdown of red blood cells, and is cleared/ processed by the liver. The form of bilirubin that is yet to be processed by the liver after being released from the red blood cells is called as unconjugated bilirubin. Once processed inside the liver, the new form of bilirubin is called as conjugated bilirubin.
Most of the time, in newborn babies who are jaundiced, the urine tends to be colourless due to increased levels of unconjugated bilirubin. The usual reasons for this unconjugated hyperbilirubinemia are either an excessive breakdown of red blood cells leading to high levels of bilirubin or an inability of the relatively immature liver to handle the bilirubin load.
If your newborn baby is jaundiced and passes yellow coloured urine that stains the diaper or passes pale yellow or white stools, it indicates that your baby has conjugated hyper bilirubinemia due to an underlying liver disease. This needs immediate medical attention by a paediatric gastroenterologist.
Jaundice in the newborn, which occurs due to such liver disease, cannot be treated with phototherapy. Besides, it may be due to an underlying serious condition called biliary atresia, which needs immediate surgery! Other conditions that may cause jaundice with yellow coloured urine and pale stools include bacterial sepsis – a serious blood infection, metabolic conditions like galactosemia, and infections of the liver – neonatal hepatitis and congenital liver diseases.
Biliary atresia is a rare condition, wherein there is progressive inflammation within the bile ducts causing a complete block of bile flow. Though this is a serious condition, it is often missed, as these babies are otherwise growing very well. It is not uncommon for the innocent first-time mom’s to mistakenly consider the white stools of the baby as ‘normal’, as these babies are on breast milk (which is also white). Special infant stool colour cards have been devised in countries like Taiwan, and are found to be very useful in picking up biliary atresia early. These colour cards can be used by mothers, nurses and paramedical staff with relative ease. One such card is displayed below.
A timely and successful surgery (kasai procedure) in an attempt to re-establish bile flow will make the baby jaundice free and retard further progression of liver disease. Failure to perform a timely/ successful kasai surgery in a child with biliary atresia will lead to progressive liver disease and death of the baby, unless the baby undergoes another major surgery called liver transplantation.
Liver transplantation is the process of replacing the diseased liver with a portion of healthy liver from another person. Biliary atresia remains the most common cause of paediatric liver transplantation worldwide, and it is important to recognise this condition early. The first successful liver transplant in India was performed in 1996, in a child with biliary atresia, by the Apollo group of hospitals. The Apollo group of hospitals continues to offer excellent world-class facilities for liver transplantation in children.
Tips for mothers
When does jaundice in a newborn need immediate medical attention?
When your baby is not gaining weight
When your baby is not feeding well
When your baby’s urine is yellow coloured and stains the diaper yellow
When your baby’s stool colour is pale yellow, creamish or white