Neonatal jaundice

DEFINITION:
Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels.

OTHER NAMES:
-Neonatal hyperbilirubinemia,
-neonatal icterus,
-jaundice in newborns.

RISK FACTORS:
-Premature birth. A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.
-Significant bruising during birth. Newborns who become bruised during delivery gets bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.
-Blood type. If the mother’s blood type is different from her baby’s, the baby may have received antibodies through the placenta that cause abnormally rapid breakdown of red blood cells.
-Breast-feeding. Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breast-feeding, experts still recommend it.

CAUSES:
-liver disease
-sickle cell anemia
-bleeding underneath the scalp (cephalohematoma) – caused by a difficult delivery
-sepsis – a blood infection
-an abnormality of the baby’s red blood cells
blocked bile duct or bowel
-rhesus or ABO incompatibility – when the mother and baby have different blood types, the mother’s antibodies attack the baby’s red blood cells
-higher numbers of red blood cells – more common in smaller babies and twins
-enzyme deficiency
-bacterial or viral infections
-hypothyroidism – underactive thyroid gland
-hepatitis – an inflammation of the liver
-hypoxia – low oxygen levels
-some infections – including syphilis and rubella

PATHOPHYSIOLOGY:
-Infant jaundice is caused by an excess of bilirubin. Bilirubin is a waste product, produced when red blood cells are broken down. It is normally broken down in the liver and removed from the body in the stool.

-Before a baby is born, it has a different form of hemoglobin. Once they are born, they very rapidly break down the old hemoglobin. This generates higher than normal levels of bilirubin that must be filtered out of the bloodstream by the liver and sent to the intestine for excretion.

-However, an underdeveloped liver cannot filter out the bilirubin as fast as it is being produced, resulting in hyperbilirubinemia (an excess of bilirubin).

-Infant jaundice with breast-feeding is common. It occurs in newborns that are breast-fed in two separate forms:

-Breast-feeding jaundice – occurs in the first week of life, if the baby does not feed well, or if the mother’s milk is slow to come in.
-Breast milk jaundice – this is due to how substances in the breast milk interfere with the breakdown process of bilirubin. It occurs after 7 days of life, peaking at 2-3 weeks.

SIGNS AND SYMPTOMS
-Yellow discoloration of the skin, mucous membranes and the whites of the eyes
-Light-colored stool
-Poor feeding
-Lethargy/excessive sleepiness
-Changes in muscle tone (either listless or stiff with arching of the back)
-High-pitched crying
-Seizures

DIAGNOSIS:
Based on symptoms, confirmed by bilirubin level

LABORATORY FINDINGS:
-A bilirubin level more than 34 μmol/l (2 mg/dL) may be visible.
-For the feet to be affected level generally must be over 255 μmol/l (15 mg/dL).

TREATMENT:
-More frequent feeding,
-phototherapy,
-exchange transfusions

COMPLICATIONS:
-Seizures,
-cerebral palsy,
-kernicterus

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