Newborn Jaundice

 

What is newborn jaundice?

Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclera and other mucous membrane caused by hyper bilirubinemia. Bilirubin is a yellow pigment produced during normal breakdown of red blood cells.

Babies who are born too early (premature) are more likely to develop jaundice than full-term babies.

Normal blood bilirubin level

• Normal Bilirubin direct (Conjugated): 0 to 0.3 mg/dl.
• Normal Bilirubin indirect (Un-Conjugated): 0.1 to 1 mg/dl.
• Bilirubin total: lower than 1.5 mg/dl.

Conjugated bilirubin is water soluble and non-toxic.
Un-conjugated bilirubin is toxic and causes neuronal dysfunction or death.

Causes of newborn jaundice

• Increase RBC volume and increase destruction of RBC due to shorter life span of fetal red blood cells.
• Abnormal blood cell shapes (such as sickle cell anemia)
• Decrease conjugated bilirubin due to decrease UDGPT activity.
• Decrease hepatic excretion of bilirubin.
• Decrease liver cell uptake of bilirubin due to decrease ligandin.
• Hemolytic disease Eg. Rh incompatibility.
• Neonatal septicemia.
• Blood extravasations.
• Congenital deficiency of glucuronyl transferase.
• Hepato-biliary obstruction.
• Galactosemia, hypothyroidism & breast milk jaundice.

Types of newborn jaundice

1. Physiological Jaundice

 Most newborn have some yellowing of the skin, or jaundice. This is called physiological jaundice. It is usually appear when the baby is 2 to 3 days old or most of the time, it does not cause problems and  disappears within 7 to10 day, a little later in premature neonates.

2. Pathological Jaundice

Pathological jaundice is serious type of jaundice and it's appear within 24 hours of birth. It is characterized by a rapid rise in a baby's bilirubin level. The most likely cause is blood incompatibility or liver disease.

Symptoms

• Jaundice causes a yellow color of the skin in newborn. It usually begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.
• Enlarged liver.
• Poor muscle tone in newborn.
• Infant looks lethargy.
• Poor sucking reflex in newborn.

Diagnosis

• Serum bilirubin test.
• Dermal Icterus zone test.

Treatment

Treatment is not needed most of the time. The treatment is depend on the baby's bilirubin level and how fast the bilirubin level rising.

1. Phototherapy:

Phototherapy is used when the newborn blood bilirubin level is very high. In phototherapy the baby is exposed in blue lights to reduce serum bilirubin level. Phototherapy converts bilirubin to lumibilirubin by photo-isomerization. It is structural isomers of bilirubin which is water soluble and excreted from the body in bile and in urine without conjugation. Nurse keep the baby well hydrated during phototherapy. During therapy nurse cover the baby eyes and genitalia to prevent form damage by light. Close monitoring of skin temperature and eye for infection is essential.

Complication of phototherapy:

Watery diarrhoea, skin rashes, dehydration, bronze baby syndrome & retinal damage.

2. Exchange Blood Transfusion:

Exchange blood transfusion is used when the blood bilirubin level is vey high and phototherapy hasn't been effective. In this procedure, the baby's blood is replaced with fresh blood.

Complication of exchange blood transfusion

Air embolism, thrombosis, hypervolemia, respiratory distress syndrome, hypothermia, acidosis, infection, hyperkalemia & hypocalcemia, cardiac arrhythmias, thrombocytopenia, necrotizing enterocolitis & coagulopathies.

Kernicterus

Kernicterus is a pathological condition characterized by yellow staining of the brain by un-conjugated bilirubin resulting in nervous tissue damage. More than 20 mg/dl un-conjugated bilirubin level cause kernicterus.

Excess rise of conjugated bilirubin in blood can’t produce kernicterus.

Symptoms of Kernicterus

Lethargy, hypotonia, poor feeding, loss of moro reflex, respiratory distress, hypertonia & finally opisthotonus, hyper pyrexia, convulsion and enlarged liver & spleen.