Newborns and jaundice

by GITA ARJUN

WOMEN AND WELLNESS Don't panic when a newborn is diagnosed with jaundice. Here's what you need to know about neonatal jaundice

Tabassum delivered her baby three days ago. Today, her baby looks yellowish and her paediatrician has told her that the baby has new-born jaundice. Is there anything to worry about?

What is newborn jaundice?

Most babies will have mild newborn or neonatal jaundice. Physiologic jaundice is the most common form of newborn jaundice.

Treatment is required when the jaundice is pronounced. Jaundice is a yellow discolouration of the skin and the white part of the eyes. When a finger is pressed gently against the baby's skin, normal skin will turn white, but jaundiced skin will stay yellow.

Newborn jaundice results from having too much of a substance called bilirubin in the blood. Most babies are born with a high amount of red blood cells. Bilirubin is formed when the body breaks down red blood cells. The liver usually processes and removes the bilirubin from the blood.

Jaundice in babies occurs because their immature livers are not efficient at removing bilirubin from the bloodstream. The type of bilirubin that causes the yellow discolouration of jaundice is called unconjugated bilirubin. This form of bilirubin is not easily removed from the baby's body. The baby's liver changes this unconjugated bilirubin into conjugated bilirubin, which is easier for the baby's body to remove. The immature livers of newborn babies are not able to perform this job very efficiently at first. As the breakdown of red blood cells slows down, and the baby's liver matures, the jaundice rapidly disappears.

Newborns will begin to appear jaundiced when they have more than 5 mg/dl of bilirubin in their blood. In an adult, bilirubin levels are considered high when the blood result shows a value of more than 1 mg/ dl. On the other hand, it is quite common to see newborns with bilirubin levels of 5 to 10 mg/dl.

It is important to recognise and treat neonatal jaundice. The level of bilirubin may be treated according to the baby's age. For example, a bilirubin level of 12 mg/dl needs to be treated if the baby is less than 48 hours old, but is considered normal when the baby is more than five days old.

Why is it important to treat high bilirubin levels?

High levels of bilirubin can cause permanent damage to a baby's brain. This brain damage is called kernicterus.

Nowadays, because of increased awareness and effective treatment of neonatal jaundice, kernicterus is extremely rare. Kernicterus will usually happen only when the bilirubin level crosses 20mg/dl in a baby born at full term. A premature baby may have damage with a lower bilirubin level.

Who is at risk for newborn jaundice?

Though most babies will develop some degree of newborn jaundice, some babies are at higher risk for developing significant levels of jaundice.

The risk for newborn jaundice increases if:

The mother's blood group is O and the baby's blood group is A, AB or B. This is called ABO incompatibility.

The mother is Rh negative and the baby is Rh positive. This is called Rh incompatibility.

The baby is premature.

The mother had diabetes during pregnancy.

Treatment of newborn jaundice

Jaundice is most often treated with phototherapy. This involves placing the baby beneath special lights. Two factors help decide whether or not to start phototherapy: the age of the child and the level of bilirubin. If the baby develops jaundice within the first few days, phototherapy is definitely started. The level of bilirubin in the blood is assessed to decide when the phototherapy should be started and how long it should be continued. A premature baby will be started on phototherapy earlier than a full-term baby.

The light used for phototherapy is able to penetrate a baby's skin. The light changes bilirubin into a soluble form that is easily handled by the baby's body. Special eyeshades are placed over the baby's eyes to shield them from the lights. When all other treatment has failed to reduce the bilirubin level, the last resort is an exchange transfusion. In this treatment, the baby's blood is exchanged with donated blood. This is a specialised procedure and is done only in centres where there are neonatologists who care for critically ill newborns.

(The author is an obstetrician and gynaecologist practising in Chennai and has written the book “Passport to a Healthy Pregnancy”.

www.passport2health.in )