Neonatal Jaundice In Newborn: Symptoms, Diagnosis, and Treatment

What is Jaundice?

Jaundice, or icterus, is a condition where the skin and the whites of the eyes turn yellow due to high levels of bilirubin in the blood.Bilirubin is a breakdown product of red blood cells which is usually removed from the body by the liver.

Newborn babies, particularly premature infants, babies with G6PD and blood group incompatibility are vulnerable to jaundice in view of rapid red blood cells breaking down.

Normal bilirubin levels in blood are below 1.0 mg/dL, while levels above 2-3 mg/dL typically indicate jaundice in newborns. Premature babies or those with blood group incompatibilities are more prone to jaundice due to rapid red blood cell breakdown.

Jaundice Levels in Newborns

• Mild Jaundice: Bilirubin levels slightly above normal (e.g., 2-3 mg/dL), typically resolving without treatment.
• Moderate Jaundice: Bilirubin levels requiring phototherapy (e.g., 12-18 mg/dL).
• Severe Jaundice: Bilirubin levels that may necessitate an exchange transfusion or other interventions (e.g., above 18 mg/dL).

Symptoms of Newborn Jaundice

Newborn jaundice is characterised by a yellowish tint to the skin and the whites of the eyes, caused by high bilirubin levels in the blood. The symptoms may be more noticeable in certain areas of the body, including:

• The whites of the eyes
• Inside the mouth
• On the soles of the feet
• On the palms of the hands

In newborns with brown or black skin, yellowing may be harder to detect, but pressing on the skin may make the yellowing more visible. The yellowing is often most noticeable on the head and face.

Other signs of jaundice in newborns include:

• Sleepiness or lethargy
• Reduced feeding or difficulty feeding
• Dark yellow urine (should typically be colourless)
• Pale or white-coloured stool (should typically be yellow or orange)

Jaundice typically appears about 2 days after birth and resolves within 2 weeks for most babies. Premature infants may experience jaundice for 3 weeks, and it can last longer in babies who are exclusively breastfed, occasionally extending up to a few months.

How is Jaundice Monitored?

Your newborn will typically be examined for jaundice within 72 hours of birth as part of the routine newborn physical examination. Doctors or nurses will check babies for signs of jaundice by looking at the skin colour and asking about the baby’s urine and stool. If jaundice is present, the babies would be further assessed by blood test or using a bedside machine (transcutaneous bilirubinometer) to measure the jaundice level. 

While jaundice is usually harmless and clears up on its own, it's crucial to monitor bilirubin levels and seek professional advice to determine whether treatment, such as phototherapy, is required.

What Causes Jaundice?

Jaundice occurs when there is too much bilirubin in the blood, a condition known as hyperbilirubinaemia. Bilirubin is produced when red blood cells break down and is normally processed by the liver, which removes it from the body through stool. However, if the liver can't process bilirubin effectively, excess bilirubin causes jaundice.

Newborns are prone to jaundice because their livers are not fully developed and cannot process bilirubin as efficiently as adults. As babies have a high number of red blood cells, which are broken down frequently, bilirubin levels can rise. By 2 weeks of age, the liver matures, and jaundice usually resolves on its own.

Breastfeeding and Jaundice

Breastfeeding may increase the risk of jaundice, but it does not require stopping breastfeeding. In most cases, jaundice clears within a few weeks, although it can persist for up to 12 weeks in some breastfed babies. It’s essential to monitor for other potential causes and seek medical advice if needed.

Underlying Health Conditions

In rare cases, jaundice may be caused by an underlying condition, known as pathological jaundice. These conditions can include:

• Hypothyroidism (underactive thyroid)
• Blood group incompatibility or rhesus disease
• Urinary tract infections (UTIs)
• Crigler-Najjar syndrome (a genetic disorder affecting bilirubin processing)
• Blockages in bile ducts or gallbladder
• G6PD deficiency (an inherited enzyme deficiency)

If you have a family history of G6PD deficiency, inform your healthcare provider to ensure proper monitoring of your baby’s jaundice symptoms.

Diagnosis of Newborn Jaundice

Your baby will be checked for jaundice within 72 hours of birth during the newborn physical examination. However, jaundice may not appear until up to a week later, so it's important to monitor your baby at home for symptoms.

Look for yellowing of the skin and the whites of the eyes. Gently pressing on the tip of the nose or forehead can make yellowing more visible. Additionally, check the baby's urine (which should be colourless) and stool (which should be yellow or orange). Yellow urine or pale stool may indicate jaundice.

Visual Examination

Your baby will be examined under natural light to check for yellowing of the skin, eyes, gums, and the colour of their urine and stool.

Bilirubin Test

If jaundice is suspected, a bilirubin test will be performed to measure bilirubin levels. This can be done using:

• Bilirubinometer: A small device that shines light on the skin to measure bilirubin levels.
  
  
• Blood test: A blood sample from a heel prick is taken to measure bilirubin levels in the serum.

Blood tests are generally needed only if jaundice appears within the first 24 hours or if bilirubin levels are high. The results help determine whether treatment is required.

Further Tests

If jaundice persists beyond two weeks or treatment is necessary, additional blood tests may be performed to determine:

• The baby’s blood group and compatibility with the mother’s
• Presence of antibodies on red blood cells
• The number of red blood cells
• Possible infections or enzyme deficiencies

These tests help identify any underlying causes for the elevated bilirubin levels.

How is Jaundice Treated?

Treatment is typically only necessary if your baby has high bilirubin levels. In most cases, jaundice resolves on its own within 10-14 days, especially when bilirubin levels are low. Continue breastfeeding or bottle-feeding regularly, even if your baby is sleepy. If jaundice persists beyond 2 weeks or worsens, contact your healthcare provider for further evaluation.

Phototherapy

If bilirubin levels are high, phototherapy may be used to help your baby’s liver break down the excess bilirubin. Your baby will be placed under special light with their eyes covered. Phototherapy is effective and typically requires monitoring every 4-6 hours to ensure bilirubin levels are dropping. If needed, intensified phototherapy can be used, though it requires continuous treatment without breaks.

Exchange Transfusion

In severe cases where phototherapy is ineffective, an exchange transfusion may be necessary. This procedure removes your baby’s blood and replaces it with donor blood, quickly reducing bilirubin levels. The process is closely monitored for any complications.

Other Treatments

If jaundice is caused by an underlying condition, like an infection or rhesus disease, appropriate treatments like intravenous immunoglobulin (IVIG) may be required.

How Long Will Jaundice Last?

The length of time babies remain jaundiced is different for each baby. Usually, bilirubin levels increase over the first few days, then decrease slowly over the next 1-2 weeks. Regular blood tests may be taken to monitor bilirubin level before deciding to stop phototherapy.

Does Jaundice Cause Any Concern?

For most babies, jaundice does not cause significant medical problems with regular monitoring. Very rarely, the extremely high level of bilirubin can cause hearing loss or cerebral palsy if not treated early.

If the babies remain jaundiced more than 2-3 weeks old, they should be assessed by medical doctors to exclude other important medical conditions such as extrahepatic biliary atresia, congenital hypothyroidism, urinary tract infection, and neonatal liver disease.

Make an appointment at Gleneagles Hospital Penang

Get in touch with us to find out more about our Paediatrics Services at Gleneagles Hospital Penang, if you have any questions about neonatal jaundice.