In detail

Jaundice in newborns

Jaundice in newborns

Jaundice is a condition characterized by yellow coloration of the skin and the white part of the eyeball (sclera) and is the consequence of the accumulation of a large amount of bilirubin in the blood (hyperbilirubinemia). Bilirubin is produced by destroying red blood cells (blood cells) and hemoglobin.

Hemoglobin is a protein found in blood vessels that has the role of transporting oxygen from the lungs to the tissues in the rest of the body.

Newborn jaundice usually occurs after approximately 24 hours after birth. In the case of healthy newborns, fed with breast milk, a certain degree of yellow tegumentary coloration appears about 2-4 days after birth. Jaundice disappears or decreases in intensity by itself, without treatment and without follow-up in 1-2 weeks.

In the case of newborns breast-fed, a mild jaundice may be sustained 10-14 days after birth or may recur during breastfeeding. As long as the baby receives enough milk and is fed frequently (8-10 or more times within 24 hours), jaundice is not a problem.

However, the child should be supervised. Rarely large amounts of bilirubin accumulate in the blood and cause brain damage, the condition known as nuclear jaundice. These injuries can be followed by hearing loss, mental retardation and behavioral disorders.

Causes

Jaundice occurs as a result of the imbalance between bilirubin production and elimination. It is removed from the human body through urine and stool (feces). During pregnancy, the mother's body removes bilirubin from the fetus through the placenta. After birth, the newborn must remove bilirubin from the blood alone. In newborns, bilirubin may have increased values, up to concentrations that cause the yellow coloration of the skin and mucous membranes, due to the immaturity of organs that cannot cope with the rate at which bilirubin must be eliminated from the body. Dehydration can easily occur in newborns and lead to slowing of urine and faeces formation, which results in increased bilirubin elimination time.

The metabolism of bilirubin is also influenced by some substances that enter the composition of breast milk. In rare cases, hyperbilirubinemia can be caused by other conditions or diseases, such as diseases of the digestive tract, infections or blood group incompatibilities.

Symptoms

The most common manifestation of jaundice in newborns is the staining of the skin and sclera or the buccal mucosa in yellow. Usually, the yellow color first appears on the face and chest, within the first 5 days after birth, although the day of onset varies from one newborn to another or depending on the type of jaundice.

Physiological jaundice occurs in all children (some are low intensity and goes unnoticed) beginning after the first day of life, because the baby's organs are not yet able to effectively remove excess bilirubin. The intensity of jaundice increases after the first day from birth until day 3-4 of life. Usually the level of bilirubin in the blood reaches a plateau level (constant for several days) and then gradually decreases, so that the coloration decreases or even disappears in about 1 week without being followed by any complication.

The jaundice that appeared during breastfeeding is caused by a mild dehydration that prolongs and intensifies the physiological jaundice. Dehydration contributes to the onset of jaundice, because it hinders the elimination of bilirubin from the body by the specific but immature systems of the newborn. This type of jaundice can occur when the newborn does not receive enough fluids. This usually happens when the tables are at too long intervals. Typically, increasing the frequency of meals the child has as a result the decrease or disappearance of this type of jaundice between days 5-7 of life.

The jaundice caused by breast milk causes the increased circulating level of bilirubin, which occurs around days 10-14 of life. The mechanism by which some components of breast milk affect the elimination of bilirubin by the newborn is not known. This type of jaundice begins to disappear in the second month, although a slight yellowish hue may persist throughout breastfeeding.

Rarely, the newborn's jaundice may be caused by some of its associated conditions. The yellow coloration of the skin that appears less than 24 hours after birth, is rarely the cause of neonatal jaundice and these children should be investigated for other causes.

If this coloration continues to increase in intensity after the third day of life or does not decrease after the fifth day of life, a specialized medical consultation is recommended. It should be noted that increasing the frequency of meals for the child may be helpful and may be followed by lowering bilirubin levels. If very high levels of bilirubin are not treated, complications may occur.

The specialized consultation

Signs showing an increased level of bilirubin in the blood

The specialized medical consultation is urgently required when the newborn shows signs and symptoms that indicate an increased level of bilirubin in the blood, such as:

  • thinning and loss of ability to suck
  • irritability, tremors and crying
  • arching the back
  • shrill scream of high pitch.

Signs of a very high level of bilirubin

  • periods of stopping breathing (apnea) or difficult breathing (dyspnea)
  • convulsions.

Treatment for jaundice in newborns

In most cases it is not necessary to treat jaundice (hyperbilirubinaemia) in newborns. However, it is necessary to follow the children in order to observe the occurrence of possible changes in skin tone and behavior.

Children who have dangerously high levels of bilirubin in their blood need treatment. Regardless of the cause, high levels of bilirubin left untreated can lead to brain damage (nuclear jaundice) resulting in hearing loss, mental retardation and behavioral disorders. The most used method of therapy is phototherapy.

It uses fluorescent light that intensifies the transformation of bilirubin into a form that the body can eliminate at a faster rate. Standard phototherapy is usually applied in the hospital. In the case of children who are no longer suffering from other diseases, there is a method of treatment at home that uses a device made of optical fibers, in the form of beds. These "beds" reduce bilirubin levels more slowly than standard phototherapy, which is why they are used only for the treatment of mild forms of jaundice. Sometimes both types of therapy can be used concurrently.

Mothers whose newborns are treated in the hospital with phototherapy can be with them:

  • staying with children overnight, and if this is not possible, frequent visits are recommended
  • They can reach their children often during phototherapy sessions, when they are in the incubator
  • singing or talking to children because they can hear when they are in the incubator
  • holding children in their arms during periods when they are removed from the incubator.

Fluorescent light used during phototherapy is not harmful if used cautiously. During therapy, the baby's eyes will be protected. Devices used for eye protection are removed during feeding. Newborns are used to the darkness after months spent in the womb, so these devices should not bother them. When the child undergoes home therapy, it is very important for parents to understand how the device works.

If you have any complaints or disagreements, you can consult your specialist doctor. The amount of bilirubin in the blood of the child should be monitored daily. If the baby's jaundice has other causes, specific treatments are required. For example, if the jaundice is severe and caused by the massive destruction of the red cells by the body of the child, it is necessary to hospitalize the child and blood transfusion.

Treatment (at home)

Parents are often asked to follow their newborns to detect signs of jaundice. Most mothers and their newborns leave the hospital within the first 48 hours after the baby is born, before the jaundice is observed.

The newborn should then be examined by the family doctor within the first 4-5 days after birth. When the baby becomes jaundice but does not require phototherapy, the parents will be asked by the doctor to follow the newborn carefully, to observe the increase in the intensity of the jaundice or behavioral changes.

To observe the changes in the intensity of the color of the skin, parents are asked:

  • to completely undress the child and carefully observe the skin 2 times a day; for children of the black race, it is recommended to observe the changes in the sclerosis; parents should keep in mind that the baby's skin is cooling rapidly and it should be covered in a blanket after one minute.
  • to examine the child at the same time every day, in the same room in the same brightness conditions
  • to notify the specialist when observing the increase of the jaundice intensity.

The best outpatient treatment for jaundice is usually nutrition, whether it is in the breast or with the bottle. Frequent feeding of the child (8-10 times a day) provides the child with the fluids necessary for the body to eliminate excess bilirubin. In the case of children who are no longer suffering from other diseases, there is a method of treatment at home that uses a device made of optical fibers, in the form of beds.

These beds reduce bilirubin levels more slowly than standard phototherapy, which is why they are used only for the treatment of mild forms of jaundice. Sometimes both types of therapy can be used concurrently. When the child undergoes home therapy it is very important for parents to understand how the device works. If you have any complaints or disagreements, you can consult your specialist doctor. The amount of bilirubin in the blood of the child should be monitored daily.

The yellow coloration of the sclera and the tegument does not disappear immediately after the treatment by phototherapy. If the color intensifies, the specialist must be notified.

Sometimes parents try to treat this condition on their own without having the necessary equipment. Exposure of the child to sunlight does not reduce the level of bilirubin in the blood, but the skin of the child may suffer burns. In addition, the baby may be cold and therefore a special light and controlled environment is required for the safe treatment of jaundice.

There are mothers who believe that breastfeeding should be stopped in case of jaundice. International associations recommend continuing nursing with the newborn with jaundice, as well as increasing the frequency of meals. In the case of children admitted to the hospital, it is recommended that mothers move to maintain their milk production. The milk thus collected can be used to feed the hospitalized child.

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