Hello Mums….Let us talk about Jaundice in the Newborns.
This is one condition that is very common in newborns and often associated with serious consequences if not well-managed.
It is so disheartening how many cases of poorly managed cases of Jaundice in the newborn we do have in this environment from ignorance. This has led to unnecessary deaths and disabilities in the children. So, let us know more about this important condition.
Two Key words in this topic  – Jaundice and Newborn
What is Jaundice? evaluate your child and confirm the diagnosis.
Jaundice is the yellowish discoloration of the skin, sclera (white)Â of the eyes.
Who is a Newborn?
Newborn is a baby from Day 0 that is the first day of life to Day 28…..that is the first month of life; also called neonates.
Another word for Jaundice in the newborn is Neonatal Jaundice.
How common is Jaundice in the Newborn?
Jaundice is the commonest condition in a Newborn.
In fact 2 out of every 3 newborns born at normal time (term) will have jaundice (60%) while 4 out of every 5 newborns born prematurely (preterm) will have jaundice (80%).
Why is Jaundice so common?
Before we discuss the causes of jaundice, let us know how jaundice occurs and then we will understand how it is so common in other words the mechanism of Jaundice.
Jaundice is actually due to high level of a substance called BILIRUBIN in the blood of the Newborn. It is this Bilirubin that is actually yellow in colour…..and it is the staining of the eyes and skin by bilirubin that causes the yellowish discolouration known as Jaundice.
In fact another name for jaundice in newborn is Neonatal Hyperbilirubinaemia…..too much bilirubin.
Remember this bilirubin, because all problems from Jaundice is the bilirubin and all treatment for jaundice in the newborn is to remove bilirubin or at least to make it safe because bilirubinis toxic or poisonous to the brain of a newborn. If you understand this alone, you already have an A in this online course NNJ 101
Bilirubin is a substance that is produced when red blood cells no longer needed by the body are broken down. So it is a waste product of red blood cells breakdown that should be removed from the body. This job of removing this bilirubin is done by the liver normally.
In adults, this is not an issue because the red blood cells survive for 120 days in normal healthy adults and after it is old and broken down, the bilirubin is removed by the liver which is matured and there is usually no problem in healthy individuals.
Now in newborns, there are issues with this mechanisms and that is why jaundice is so common in them apart from even abnormal conditions that can also cause jaundice.
- The newborn has too many red blood cells compared to adult. This is because they need many to steal away oxygen from the mum in the womb since they are not breathing in air directly for their own oxygen. The amount of red blood cells in average mum what we call PCV is 36% while in a newborn it is usually 42% or more. That is why they all look so pink or red at times. When the baby is born, he or she can now get oxygen directly and does not need so many red blood cells, the extra have to be destroyed which means more bilirubin production.
- The Red blood cells of the newborn unlike that of adult has a short life span. Compared to the 120 days in the adults, the newborn red cells have a life span of 35 days onl!!! So many red blood cells destroyed so early.
- Finally, the Liver in the newborn is still immature so it cannot handle so much bilirubin that are produced by the destruction of the red blood cells. This is why the bilirubin initially become high in the blood causing yellowish staining of the skin and eyes before the liver is able to handle and clear them away from the system eventually.
These challenges are even more compounded in the premature babies.
Types of Jaundice in the newborn
So the above-mentioned mechanisms can happen in any newborn and cause Jaundice; however, there are also conditions that can also cause jaundice in the newborn apart from the normal challenges.
There are 2 types of Jaundice
- Physiological Jaundice.
- Pathological Jaundice
Now when Jaundice occurs as a result of normal overwhelming of the body system to clear jaundice, we call it Physiological Jaundice and it is the commonest type of jaundice.
When Jaundice occurs as a result of disease or abnormal conditions in the newborn, we call it Pathological Jaundice.
Jaundice can also be conjugated or unconjugated in medical jargons but don’t worry about that…leave that for the medicos, just mention it in passing should your doctor say it. It actually means the type of bilirubin that is more in the blood. The bilirubin the liver has not worked on at all is Unconjugated and is the toxic one to the brain. The bilirubin the liver has partially worked on is the conjugated and is safe but when it is high it means something is wrong as well.
Physiological Jaundice
How do you know your baby’s jaundice is the physiological type?
Physiological jaundice:
- This results from increased red blood cells breakdown and immature liver function.
- It presents at 2 or 3 days old, begins to disappear towards the end of the first week and has resolved completely by day 10.
- The bilirubin level does not usually rise above 12mg/dL and the baby remains well – sucking, no fever, no abnormal movement, nothing else than the jaundice.
However, the bilirubin level may go much higher if the baby is premature (up to 15mg/dl) or if there is increased red cell breakdown – eg, extensive bruising, cephalohaematoma(bleeding under the scalp).
This is the situation that your baby has jaundice but the doctor tells you AFTER checking the blood bilirubin (SERUM BILIRUBIN – SB) levels, NOT TO WORRY and may even discharge you without ANY TREATMENT.
Pathological Jaundice.
The following scenarios mean the jaundice is due to abnormality or disease conditions – that is the jaundice is pathological
- Jaundice in the first 24 hour of life
- Total Serum Bilirubin concentration greater than 12mg/dl (204umol/L) at any point in time
- Serum Bilirubin concentration increasing by more than 0.5mg/dl per hour or 5mg/dl per day
- Conjugated bilirubin of > 2mg/dl (34umol/L)
- Jaundice persisting for more than two weeks
- Haemolytic jaundice where the baby’s blood level is also dropping (anaemia).
Causes of Jaundice
There are very many causes of Pathological Jaundice, in fact sometimes despite all our tests we never discover sometimes the cause.
The Most Common Causes of Pathological Jaundice especially in our own environment (Nigeria) are:
Unconjugated hyperbilirubinaemia
- ABO incompatibility.
- G6PD deficiency.
- Neonatal sepsis.
- Prematurity.
- Rhesus incompatibility.
- Breastfeeding jaundice.
- Breastmilk jaundice.
Conjugated hyperbilirubinaemia.
- Neonatal hepatitis syndrome – can be infectious or biochemical.
- Infections like Hepatitis B, TORCHES – Toxoplasmosis, Cytomegalovirus, Rubella, Herpes, Syphilis.
- Biochemical like Galactosaemia, alpha-1-antitrypsin deficiency.
- Biliary atresia – can be intrahepatic or extrahepatic biliary obstruction.
In Part 2, we will touch on the right treatment of Jaundice in the Newborn, expose the myths surrounding jaundice, dangers/complications of Jaundice and methods of preventing jaundice where feasible.
I will be glad to answer your questions – send the comments in or email me at askthepaediatricians@gmail.com
Thanks so much for this.is there any way this could be prevented during pregnancy
Kindly read the second part of the article here about prevention of jaundice. Not all cases of Jaundice are preventable in pregnancy though.
Thank you so much, this has been helpful,
Good morning doctors. Kindly help procure a solution to my questions. Firstly, why do i feel slight pain in my other breast when my baby is sucking? Secondly , is it ok for my 10 weeks baby to stop pooing the melon like poo?
It is normal and as the breast become softer the pain will be less. It could also be due to the baby grabbing the nipple instead of the areola where the milk sinuses are. Read the articles on breastfeeding here and here
Good pm doc
Please I have a question, my 9days old baby opened his eyes this evening and I discovered he had a little blood stains in the right eyes and the white part is a bit yellowish,he sucks well,please am I suppose to be worried?
Yes about the yellow part because that is Jaundice. The blood will eventually clear nothing to worry about that. You need to take the baby to the hospital immediately to see a Paediatrician and the level of the jaundice measured so the appropriate intervention can be instituted if necessary. Please treat as urgent.
Please doc my 22 days old child has had blood stains in eyes 3 days after birth but has cleared up now , she has white tongue, she had stuffy nose last one week and light cough but now the cough is hard, but she feeds well and sleep well with no fever . what should I do
First time Mum? Only an FTM will lump several questions in one paragraph. I am happy the eyes have cleared. As regards the stuffy nose and cough, kindly keep the baby warm and breastfeed exclusively. If the cough is not better or getting worse especially if associated with fast breathing, you need to take her to see a Paediatrician immediately. Kindly also keep the baby away from those with colds and cough as well.
Please doc, my baby doesn’t have yellow skin or eyes but he SB test show total 4.9 and direct 3.3 please what might be the cause.
That is within normal levels and will not show as Jaundice ie yellow eyes. You did not tell us the age of your baby and why the SB test was done if the child has no jaundice.
Good day ma, can a baby of 3months still show up symptoms of rhesus incompatibility. Because I read it online that symptoms might still show after 3month.
I am not sure what you read online and what your concerns are. It is better to tell us what the symptoms are and what concerns you have so we can advise specifically on the next steps.
Thank you Dr for this article.
An SB test was carried out on my 3 days old daughter. The result showed 5.3 and we were discharged saying it’s nothing serious.
But getting home now, I realise that her eyeballs are not white though it’s not yellow too.
Please I hope there’s no cause to worry? Thank you.
I will not worry. You can also go back for a repeat check in 2 days to be sure the SB level is still low and not of concern.
My baby had jaundice after 3days of birth.the first SB we did was 9.2 . . Then we did phototherepy for 5days. when my baby was 9days we did another SB and it was 8.4. We did photoherapy for a day before going home. He is 2weeks old now. Is it possible that the jaundice will still be there. His eyes are not bright. He has not be givien BCG, can I give him now or after the jaundice has cleared.
Most likely the jaundice has cleared but you can go back and have a repeat check just to be sure. The baby can take BCG. Jaundice has nothing to do with immunization.
Please doctor my baby has been running temperature since the day she was born. 2 days now. And she has been taking Zinnat since yesterday and till now, no improvement. Please kindly help me out
Zinnat is not the treatment of cold. It is antibiotics abuse. Read about handling colds in children here
Pls Dr, can severe malaria in pregnancy cause jaundice in newborn
NO!
Please doctor, the range of my baby’s jaundice for SB rest is about 14. He has been put under phototherapy and thank God it is reducing. We discovered this obvious yellowish at his 10 days of life. Then we took action immediately. Doctor, I hope this level of jaundice can not cause damage to his brain?
It should not especially since the child is under phototherapy….all the best!
My baby of 7 days was diagnosed with SB of 16.0…………i want to ask if it’s still okay. Thanks
That is not okay…You should see your Paediatrician for proper management of the jaundice.
Thanks Doctor for your kind advice. My baby has been discharged at an SB of 1.9. We were not given any take home drugs and no further check up or appointment. Please doctor I hope there is no cause for alarm? Since there’s no further appointment for check up. Thank you once again as I await your response.
There is no cause for alarm but ideally all newborns should be followed up by doctors at 2 and 6 weeks and all other immunization dates
Good evening ma.God bless you for all u do.my baby was diagnosed of jaundice.initiqlly d SBR was 14,he was placed under phototherapy n it reduced to 11 . FBC n G6PD was done n it came out normal.d eyes is still not as white as it is suppose to b.was told it is probably breast milk jaundice.hope Derek’s nothing to worry about as I read it could cross to deir brain
The most important thing is to check the level of jaundice again and be sure the serum bilirubin level is coming down. There is no need to worry about the eyes; will eventually clear as long as the jaundice level keeps coming down.
My baby is 3 months now and his eyes is yellowish and his urine but I have taken to the hospital and has been given injection but is still there what can be the cause
Yellowish eyes is called Jaundice….and if a baby is still having yellow eyes at 3 months; that is prolonged jaundice. I will advise you see a Paediatrician for further investigations into the cause of the jaundice.