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Infant Jaundice

Definition


Disease: Infant Jaundice Infant Jaundice
Category: Children diseases

Disease Definition:

When the baby’s skin and eyes look yellowish, this could mean that the infant has jaundice. This is the result of the buildup of bilirubin, a yellow colored pigment of red blood cells in the baby’s blood. As the baby’s liver isn’t sufficiently mature to eliminate the extra bilirubin from the bloodstream, infant jaundice occurs.

 

This condition is especially common in babies born before 36 weeks gestation (preterm babies). Infant jaundice may occasionally be the outcome of an underlying disease. Infant jaundice usually doesn’t require treatment and this condition mostly improves with noninvasive therapy. Severe infant jaundice or poorly treated jaundice can result in brain damage, even though complications rarely occur.
 

Work Group:


Symptoms, Causes

Symptoms:

The following are signs of infant jaundice that are often apparent between the second or fourth day of life:

  • Yellowing of the eyes
  • Yellowing of the skin

 

Infant jaundice will primarily be obvious in the baby’s face. The yellow color in the baby’s eyes, abdomen, legs, arms and chest may be more apparent as the condition develops to more severe levels. In order to know whether the baby is experiencing an infant jaundice or not, the parent can press their finger gently on the baby’s forehead or nose; if the skin looks yellow where they pressed, then the baby is probably going through infant jaundice. Otherwise, the skin color should simply look slightly lighter than normal for a moment. It’s best to check the baby in good lighting conditions, preferably in natural daylight. Most hospitals have a policy of checking a baby for jaundice before they are discharged.

 

The baby should have a follow-up appointment to check for jaundice within two days in case he/she is discharged earlier than 72 hours after birth. Generally, babies are checked for jaundice when they are between 3 and 5 days old when bilirubin levels often peak. Sometimes, an earlier follow-up visit may be recommended that is, earlier than two days.
Severe jaundice or complications from it may be apparent by the following signs and symptoms, in which case the doctor should be called:

  • The baby’s skin looks yellow on the abdomen, legs or arms
  • The baby’s skin becomes more yellow
  • The baby makes high-pitched cries
  • Jaundice persists for  more than three weeks
  • The whites of the baby’s eyes look yellow
  • The baby is either feeding poorly or isn’t gaining weight
  • The baby develops any other signs or symptoms that worries the parents
  • The baby appears to be listless, sick or difficult to wake.
     

Causes:

The yellow color of jaundice is the outcome of an agent called bilirubin, which is a normal part of the waste produced when “used” red blood cells are broken down. Bilirubin is filtered by the liver from the bloodstream then released into the intestinal tract. A mother’s liver removes bilirubin from the baby’s blood prior to birth. Bilirubin is removed from the body in the stool.

 

In addition to an immature liver that usually is unable to remove bilirubin fast enough, a newborn infant has a relatively fast rate of producing and breaking down of red blood cells, and a large amount of red blood cells. Jaundice due to these normal newborn conditions, or physiologic jaundice is commonly apparent on the 2nd or 3rd day of life. Hyperbilirubinemia is the name given when there is extra bilirubin in the blood. The term “jaundice” is usually used as shorthand for the longer term of hyperbilirubinemia, despite the fact that jaundice is only a sign of hyperbilirubinemia.

 

Other causes:

Jaundice may be the result of an underlying disorder, in which cases it is usually apparent much earlier or much later than physiologic jaundice. The following diseases or conditions can result in jaundice:

  • Other viral or bacterial infections
  • An abnormality of the baby’s red blood cells
  • An enzyme deficiency
  • Internal bleeding (hemorrhage)
  • An incompatibility between the mother’s blood and the baby’s blood
  • A liver malfunction
  • An infection in the baby’s blood (sepsis)

 

The following are major risk factors for jaundice, especially severe jaundice that could result in complications:

 

Premature birth:

In addition to feeding less and having fewer bowel movements in comparison with full-term babies, premature ones may be unable to process bilirubin quickly. These conditions cause less bilirubin to be eliminated in the baby’s stool.

 

Bruising during birth:

Babies are occasionally bruised during the delivery process; in these cases, they may have a higher level of bilirubin due to the breakdown of more red blood cells.

 

Blood type:

In case the mother’s blood type differs from her baby’s, the baby may have received antibodies from them through the mother’s placenta, which results in the faster breakdown of the baby’s blood cells.

 

Breast-feeding:

There’s a greater risk of jaundice in breast-fed babies, especially in those who are having tough time nursing or are unable to get sufficient nutrition from breast-feeding. Jaundice may be the result of dehydration and low intake of calories due to poor breast-feeding.
 

Complications

Complications:

Serious complications can result from severe jaundice that isn’t promptly treated.

 

Acute bilirubin encephalopathy:

Acute bilirubin encephalopathy is a name given to the condition of a baby that has severe jaundice and that involves a risk of bilirubin passing into his/her brain because bilirubin is toxic to the cells of the brain. Irreversible damage may be prevented with early and urgent treatment. Acute bilirubin encephalopathy may result in the following signs in a baby suffering from jaundice:

  • High-pitched crying
  • Fever
  • Backward arching of the neck and body
  • Listless, sick or difficult to wake
  • Poor sucking or feeding

 

Kernicterus

When acute bilirubin encephalopathy results in irreversible damage to the brain, a syndrome called kernicterus occurs that may cause:

  • Permanent upward gaze
  • Intellectual impairment
  • Involuntary and uncontrolled movements (athetoid cerebral palsy)
  • Hearing loss
     

Treatments:

Usually, within 2 or 3 weeks, mild jaundice goes away on its own in contrast to moderate or severe jaundice that may require for the baby to stay longer in the newborn nursery or be readmitted to the hospital. The following are treatments used to lower the level of bilirubin in the baby’s blood:

 

Light therapy (phototherapy): 

The baby may be positioned under special lighting emitting light in the blue-green spectrum, which helps in changing the bilirubin molecules’ shape and structure in order to help in its excretion in the urine and stool. The light isn’t an ultraviolet one, and a protective plastic shield filters out any ultraviolet light that may be emitted. The baby will wear only a diaper and protective eye patches during this treatment. A light-emitting pad or mattress may be supplementing the light therapy.

 

Intravenous immunoglobulin (IVIg): 

The baby may carry antibodies from the mother because Jaundice may be associated with blood type differences between the mother and the baby. This condition may lead to the breakdown of blood cells in the baby. Jaundice may be reduced with intravenous transfusion of immunoglobulin, a blood protein that is able to decrease levels of antibodies lessening the need for exchange blood transfusion.

 

Exchange blood transfusion:

Though seldom, a baby may need an exchange transfusion of blood when other treatments haven’t been beneficial for the severe jaundice. Withdrawing over and over small amounts of blood may be required, diluting out the bilirubin and maternal antibodies, and then transferring blood back into the baby; a procedure that’s done in a newborn intensive care unit.
 

Prognosis:

Not available

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