jaundice in newborn

Jaundice in Newborn / Neonate


KNOW WHAT IS JAUNDICE IN NEWBORN/CAUSES OF JAUNDICE IN NEWBORN / SYMPTOMS / DIAGNOSIS / TREATMENT

Jaundice in newborn

WHAT IS JAUNDICE IN NEWBORN?

“Jaundice” is the word doctors use when a baby’s skin or white part of the eye turns yellow.

It is a common condition, particularly in babies born before 38 weeks gestation (preterm babies) and breast-fed babies.

This happens when a baby has high levels of a substance called “bilirubin” in the blood.

So , it is important that a baby gets checked for jaundice to see if he or she needs treatment. Because very high bilirubin levels can lead to brain damage.

HOW TO TELL IF BABY HAS JAUNDICE ?

It might be difficult to diagnose yourself but still you can tell if your baby has jaundice by pressing one finger on your baby’s nose or forehead. Then lift up your finger. If the skin is yellow where you pressed, your baby has jaundice.

Jaundice can be tracked in some babies by pressing over the bony prominences of the chest, hips, and knees to check if the jaundice is progressing.

It’s best to examine your baby in good lighting conditions, preferably in natural daylight.

WHAT ARE THE SYMPTOMS OF JAUNDICE IN NEWBORN?

Jaundice causes the skin and the white parts of the eyes to turn yellow.

Color change is noticeable in the face first, and may progress down to the chest, abdomen, arms, and then finally to the legs.

However, in some infants, the head-to- toe progression of jaundice can be masked, and the jaundice may appear over the entire body like a tan.

These changes may be hard to recognize in children with a dark skin color or if a baby is unable to open eyelids.

Jaundice in newborn infant | Download Scientific Diagram

HOW TO IDENTIFY SEVERE JAUNDICE IN NEWBORN ?

A baby with severe jaundice can have orange-yellow skin, or yellow skin below the knee on the lower part of the leg. The “whites” of the eyes might look yellow, too. A baby with severe jaundice might also:

●Be hard to wake up

●Have a high-pitched cry

●Be unhappy and keep crying

●Keep bending his or her body or neck backward

CAUSES OF JAUNDICE IN NEWBORN

Jaundice is caused by the accumulation of bilirubin in the blood. It is formed when red blood cells are broken down.

It is yellow pigment is naturally removed by the liver, and then excreted in stool and urine. Bilirubin levels become elevated when bilirubin is produced faster than it can be removed.

Jaundice is common in newborns, since two to three times more bilirubin is produced during this period as compared with during adulthood.

IS IT NORMAL TO HAVE JAUNDICE IN NEWBORN ?

Benign newborn jaundice, which affects nearly all newborns, is caused by a mild to moderate elevation of bilirubin and is not usually harmful to infants.

It develops between 72 and 96 hours after birth, and usually goes away by one to two weeks after birth.

In infants who are born at 35 to 37 weeks of gestation and those who are severely jaundiced, the jaundice may require more time to resolve as normal elimination mechanisms mature.

Newborns with higher levels of bilirubin in the blood have “severe hyperbilirubinemia”, a more serious condition than physiologic jaundice.

If Infants develop has increased bilirubin within the first 24 hours after birth. you must consult your doctor immediately.

REASON FOR INCREASED BILIRUBIN MAY BE DUE TO :

●Bruising and mild injuries during delivery.

●If the mother and infant’s blood groups and types are incompatible; the mother’s immune system may attack the infant’s red blood cells.

●Inherited causes of red blood cell breakdown (such as deficiency of an enzyme called glucose-6-phosphate dehydrogenase [G6PD], which may occur more frequently among African-American, Mediterranean, and Asian races).

●Asian race or ancestry (in these infants, the ability to remove bilirubin takes longer to mature).

Bilirubin is also more slowly removed in the newborn compared with in adults because a newborn’s liver and intestines are not fully mature.

BREASTFEEDING AND JAUNDICE

Jaundice is sometimes observed in infants who are breastfed because of two different reasons:

●Breastfeeding failure occurs in infants with inadequate intake of breast milk because of difficulty in feeding, or if the mother does not have an adequate milk supply.

These infants lose a large amount of weight, thereby increasing bilirubin concentrations. Increasing the mother’s milk supply, frequent feeding, and ensuring good sucking (latch) are the best treatments for inadequate intake jaundice.

●Breast milk jaundice is thought to be due to the infant’s immature liver and intestines, which results in a slower removal process. Jaundice begins the first week after birth, peaks within two weeks after birth, and declines over the next few weeks.

Jaundice in breastfed infants is not a reason to stop breastfeeding as long as the baby is feeding well, gaining weight, and otherwise thriving. Breastfed infants with jaundice rarely need treatment unless severe hyperbilirubinemia develops. All infants with jaundice should be monitored by a doctor or nurse.

In either setting, the mother should be encouraged to continue breastfeeding because of the overall benefits of human milk.

DIAGNOSIS OF JAUNDICE IN NEWBORN

Newborn jaundice can be diagnosed by examining the infant and testing bilirubin levels in the blood.

The blood test involves collecting a small amount (less than one-half teaspoon or 2.5 mL) of blood. Results of blood testing are available in most hospitals within a few hours.

Jaundice beyond one week of age should be investigated as this may rarely be due to a serious conditions (obstruction of the bilirubin removal due to biliary atresia).

In some centers, screening for high bilirubin is at first performed by a device that measures bilirubin through the skin (referred to as transcutaneous screening).

When the skin measurement exceeds a normal value, blood testing is performed to confirm that level of bilirubin in the blood.

COMPLICATIONS OF JAUNDICE IN NEWBORN

In babies whose blood bilirubin levels reach harmful levels, bilirubin may get into the brain and cause reversible damage (called acute bilirubin encephalopathy) or permanent damage (called kernicterus or chronic bilirubin encephalopathy).

Frequent monitoring and urgent, early treatment of infants at high risk for jaundice may help to prevent severe hyperbilirubinemia.

TREATMENT OF JAUNDICE IN NEWBORN

GOAL OF TREATMENT is to quickly and safely reduce the level of bilirubin. Infants with mild jaundice may need no treatment.

Jaundice is common in premature infants (those born before 38 weeks of gestation). Premature infants are more vulnerable to higher bilirubin levels (Hyperbilirubinemia ) because brain toxicity occurs at lower levels of bilirubin than in term infants. As a result, premature infants are treated at lower levels of bilirubin.

1.Encourage feeding — Providing adequate breast milk or formula is an important part of preventing and treating jaundice because it promotes elimination of the yellow pigment in stools and urine.

TIPS ABOUT FEEDING OF BABY

Breast-fed infants should have 8 to 12 feedings a day for the first several days of life.

Formula- fed infants usually should have 1 to 2 ounces of formula every two to three hours for the first week.

You will know that your infant is getting enough milk or formula if she/he has at least six wet diapers per day, the color of the bowel movements changes from dark green to yellow, and she/he seems satisfied after feeding.

2.Phototherapy — Phototherapy (“light” therapy) is the most common medical treatment for jaundice in newborns. In most cases, phototherapy is the only treatment required.

It consists of exposing an infant’s skin to blue light, which breaks bilirubin down into parts that are easier to eliminate in the stool and urine. Treatment with phototherapy involves using special blue lights, such as blue light-emitting diodes (LEDs), and is successful for almost all infants.

Phototherapy is usually done in the hospital, but in certain cases, it can be done at home if the baby is healthy and at low risk for complications.

Infants undergoing phototherapy should have as much skin exposed to the light as possible. Infants are usually naked (or wearing only a diaper) in an open bassinet or warmer, but wear eye patches to protect the eyes.

It is important to ensure that the lamps do not generate excessive heat, which could burn an infant’s skin.

phototherapy in jaundice
HOSPITAL PHOTOTHERAPY

In some hospitals, phototherapy blankets are used. Phototherapy should be continuous, with breaks only for feeding.

blanket phototherapy in jaundice in newborn
BLANKET PHOTOTHERAPY

Exposure to sunlight was previously thought to be helpful, but is not currently recommended due to the risk of sunburn. Sunburn does not occur with the lights used in phototherapy when used properly.

Phototherapy is stopped when bilirubin levels decline to a safe level. It is not unusual for infants to still appear jaundiced after phototherapy is completed. Bilirubin levels may rebound 18 to 24 hours after stopping phototherapy, although this rarely requires further treatment.

SIDE EFFECTS OF PHOTOTHERAPY

Phototherapy is very safe, but it can have temporary side effects, including skin rashes and loose stools.

Overheating and dehydration can occur if the infant does not get enough breast milk or formula. Therefore, the infant’s skin color, body temperature, and number of wet diapers are closely monitored.

“Bronze baby” syndrome, a dark, grayish-brown discoloration of the skin and urine rarely occurs in newborn . Bronze baby syndrome is not harmful and gradually resolves without treatment after several weeks.

Hydration is important for infants receiving phototherapy to drink adequate fluids (breast milk or a supplement) since bilirubin is excreted in urine and stool. Breast- or bottle-feeding should continue during phototherapy. Use of oral glucose water is not necessary. In some babies with severe dehydration, intravenous fluids may be necessary.

There is some controversy about the practice of giving supplemental formula to exclusively breastfed infants. Parents should discuss these issues with your infant’s doctor.

3.Exchange transfusion — Exchange transfusion is an emergency, life-saving procedure that is done to rapidly decrease bilirubin levels. The transfusion replaces an infant’s blood with donated blood in an attempt to quickly lower bilirubin levels. Exchange transfusion may be performed in infants who have not responded to other treatments and who have signs of or are at significant neurologic risk of bilirubin toxicity.

PREVENTION OF SEVERE HYPERBILIRUBINEMIA (higher bilirubin levels )

Prevention of severe hyperbilirubinemia is important in avoiding serious complications. Infants who are at risk for hyperbilirubinemia need close surveillance and follow-up. The following information applies to infants who are healthy and late preterm or older (greater than or equal to 35 weeks of gestation).

Screen — Leading experts recommend that all infants have their bilirubin levels tested before going home. This is especially true for infants who are jaundiced before 24 hours of age.

Monitor — Parents and healthcare providers should monitor the infant closely if jaundice develops. Hyperbilirubinemia is usually easy to prevent and treat initially, but the complications can be serious and irreversible if treatment is delayed. You should contact your infant’s healthcare provider immediately if you are concerned about worsening jaundice.

Treat promptly — Infants with elevated bilirubin levels should be treated by a qualified doctor or nurse to safely reduce bilirubin levels and prevent the risk of brain damage. Parents and healthcare providers should not delay treatment for any reason.

CONCLUSION

Jaundice is a common condition, particularly in babies born before 38 weeks gestation (preterm babies) and breast-fed babies.

This happens when a baby has high levels of a substance called “bilirubin” in the blood.

Benign newborn jaundice, which affects nearly all newborns, is caused by a mild to moderate elevation of bilirubin and is not usually harmful to infants.

It develops between 72 and 96 hours after birth, and usually goes away by one to two weeks after birth.

Breast-fed infants should have 8 to 12 feedings a day for the first several days of life.

Formula- fed infants usually should have 1 to 2 ounces of formula every two to three hours for the first week.

Treatment of jaundice in newborn :

1.Encourage feeding

2.Phototherapy

3.Exchange transfusion


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