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NEONATAL JAUNDICE
JAUNDICE refers to the yellow colour of the skin and whites of the eyes.
It is caused by excess bilirubin in the blood. Bilirubin is the product of broken down (haemoglobin) red blood cells. High levels of bilirubin can cause deafness, cerebral palsy or brain damage in some babies.
One gram of haemoglobin produces 35 mg of bilirubin.
Compared with adults, newborn infants have a twofold greater rate of bilirubin production (6-10mg/kg/24hr versus 3mg/kg/24hr).
• Increased red blood cell mass (higher haematocrit).
• Shortened erythrocyte life span of 70-90 days (adults 120 days).
Bilirubin produced following hb breakdown is fat soluble and unconjugated(indirect). It is toxic to the central nervous system. The liver converts the unconjugated bilirubin to conjugated, water soluble (direct) form. This form is capable of biliary and renal excretion. In addition, bacteria in the neonatal intestine converts bilirubin to urobilinogen or stercobilinogen.
Normally bilirubin passes through the liver and is excreted as bile through the intestine. Jaundice occurs when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body. Reasons for this include:
• A newborn baby's still developing liver may not yet be able to remove adequate bilirubin from the blood.
• More bilirubin is being made than the infant's liver can handle.
• Too large an amount of bilirubin is absorbed from the intestines before the baby gets rid of it in the stool.
Types of jaundice
There are many types of newborn jaundice. The following are the most common.
Normal (physiological) jaundice:
This occurs in more than 50% of newborn's. It is a diagnosis of exclusion, made after careful evaluation has ruled out more serious causes (hemolysis, infection, metabolic diseases). Not more than 12mg/dl on the third day of life. (15mg/dl in premature babies; peak 5th day.)
This jaundice is due to the immaturity of the baby's liver, which leads to a slow processing of bilirubin. It generally appears at two to four days of age and disappears by one to two weeks of age.
Jaundice of prematurity:
This occurs frequently in premature babies since they take longer to adjust to excreting bilirubin effectively.
Blood group incompatibility(Rh or ABO problems):
If a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant’s red blood cells. This creates a sudden build up of bilirubin in the baby's blood. This can be prevented with an injection of Rh immune globulin (Rhogam) to the mother within 72 hours of delivery/abortion, which prevents her from forming antibodies that might endanger any subsequent babies.
Incompatibility jaundice usually begins during the first day of life. (5mg/dl on the first day or 13mg/dl thereafter.)
Breast milk jaundice (1% to 2% of breast fed babies):
Jaundice can be caused by substances produced in the mother’s breast milk that can cause the bilirubin to rise above normal level (20mg). These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from three to ten weeks.
Symptoms:
Jaundice usually appears around the second or third day of life.
It begins at the head and progresses downward face, chest and stomach, then the legs.
Also the whites of the eyes.
Diagnosis:
Gently press your fingertip on the tip of your child's nose or forehead (white/black).
Skin show white = no jaundice.
Skin show yellow = ? jaundice. Check bilirubin level.
The seriousness of the jaundice will vary based on the child's age and the presence of other medical conditions.
Treatments:
• Phototherapy with a special light that helps rid the body of the bilirubin by altering it or making it easier for the baby's liver to get rid of it.
• Exchange blood transfusion.
• Temporary discontinuation of breast feeding (1-2days).