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Neonatal jaundice is usually harmless: this condition is often seen in infants around the second day after birth, lasting till day 8 in normal births, or to around day 14 in premature births. Serum bilirubin normally drops to a low level without any intervention required: the jaundice is presumably a consequence of metabolic and physiological adjustments after birth.
All jaundice should be medically evaluated before treatment can be given.
Causes
The differential diagnosis for neonatal jaundice is quite large.
Intrinsic causes
- Membrane defects
- Non-immune
- Enzyme defects
Extrinsic causes
- Immune
- ABO incompatability
- Rh incompatability
- Other blood type mismatches
Non-hemolytic causes
Hepatic causes
- Infections
- Metabolic
- Drugs
- Total parenteral nutrition
- Idiopathic
Post-hepatic
- Biliary atresia
- Bile duct obstruction
Treatment
Infants with neonatal jaundice are often treated with bili lights, exposing them to high levels of colored light to break down the bilirubin. This works due to a photo oxidation process occurring on the bilirubin in the subcutaneous tissues of the neonate. Light energy creates isomerization of the bilirubin and consequently transformation into compounds that the new born can excrete via urine and stools. Blue light is typically used for this purpose. Green light is more effective at breaking down bilirubin, but is not commonly used because it makes the babies appear sickly, which is disturbing to observers.
Brief exposure to indirect sunlight each day and increased feeding are also helpful. A newborn should not be exposed to direct sunlight because of the danger of sunburn, which is much more harmful to a newborn's thin skin than that of an adult.
If the neonatal jaundice does not clear up with simple phototherapy, other causes such as biliary atresia should be considered.
Non-organic causes
Breast feeding jaundice
"Breastfeeding jaundice" occurs in more than 10% of breastfed infants, caused by insufficient milk intake.Breast milk jaundice
More rarely, "breast milk jaundice" occurs in about 0.5% of babies during the second or third week, caused by high levels of beta-glucuronidase in breast milk. Neither condition is a reason to stop nursing, though in these cases caregivers usually advise supplements to breastfeeding to ensure the baby is not dehydrated.Non-physiologic causes
A small percentage of infants will have "hemolytic jaundice". The infant's red blood cells will be broken down quicker because of antibodies that attack the infant's red blood cells are transferred from the mother to the baby's bloodstream. The antibodies may be due to ABO (blood group) incompatibility or Rhesus factor differences. 1
Rare causes
Rarely, neonatal jaundice may be caused by a genetic syndrome such as Crigler-Najjar syndrome.
Complications
With high doses of bilirubin (severe hyperbilirubinemia) there can be a complication known as kernicterus. This is the chief reason for neonatal jaundice to be treated. The effects of kernicterus range from fever, seizures, and a high-pitched crying to mental retardation. This is due to a staining effect on the basal ganglia leading to neuronal damage.
In neonates, jaundice tends to develop because of two factors - the breakdown of fetal hemoglobin as it is replaced with adult hemoglobin and the relatively immature hepatic metabolic pathways which are unable to conjugate bilirubin as fast as an adult.
See also
External links
"Neonatal jaundice"