Jaundice In New-born

Jaundice is characterised by a yellowish tinge to the skin and eyes. It is caused by an excess of a chemical called bilirubin, which is normally eliminated by the liver. However, a new-born's liver takes a few days to process this chemical .About six out of 10 new-borns have jaundice to varying degrees, while the condition is more common among premature babies.
If the baby is full term and healthy, mild jaundice is nothing to worry about and will resolve by itself within a week or so. However, a premature or sick baby, or a baby with very high levels of bilirubin will need close monitoring and medical treatments. Other causes of jaundice in babies include blood group antibodies (Rh or Rhesus factor & ABO incompatibilities), haemolytic anaemia, hepatitis and galactosaemia.









Symptoms of jaundice in babies

• The symptoms depend on the cause and severity, but may include:
• Yellow tinge to the skin, usually appearing first on the skin of the face and scalp
• Yellow tinge to the white parts of the eyes (sclera)
• Yellow tinge spreading to the skin of the body in moderate jaundice.
• Palms of the hands and soles of the feet turning yellow in severe jaundice
• Unusual drowsiness
• Feeding difficulties
• In some cases, light-coloured faeces and dark urine.
• Physiological jaundice explained
• Red blood cells are red because of the protein haemoglobin. Old and damaged red blood cells are broken down into their chemical components, which are then either recycled or eliminated from the body as waste. The chemical bilirubin is produced as a by-product when haemoglobin is metabolised (used) by the body. The liver helps to eliminate bilirubin as waste.

In the mother’s uterus, the baby's bilirubin is sent down the umbilical cord and eliminated by the mother's body. After birth, the baby's liver has to eliminate the bilirubin. A baby's liver may take a few days to function at full speed; in the meantime, the excess bilirubin in the baby's body causes the characteristic symptoms of jaundice.
Every new-born has elevated bilirubin, but only around 60 per cent of full-term babies will have noticeable symptoms. Treatment isn't usually necessary, unless the baby has very high bilirubin levels, or is premature or sick.

Other causes of jaundice
Jaundice can also be caused by a range of other conditions and events including:

• Breast milk – the mother's breasts produce small amounts of colostrum in the first few days after childbirth. Until the milk comes in, the limited amounts of fluid received from breastfeeding may hinder the functioning of the baby's liver. Certain enzymes in breast milk are also thought to contribute to 'breast milk jaundice'.
• Neonatal hepatitis – some of the viruses that can trigger hepatitis in babies include cytomegalovirus, rubella, and hepatitis A, B and C. In around eight out of 10 cases, the cause isn't known, but viral infections are suspected. The baby was either exposed to the viral infection in utero, or within the first month or so of life.
• Rh (Rhesus) and ABO blood group incompatibilities – the mother may produce antibodies that can attack the baby's red cells during the latter stages of pregnancy. This means that higher than normal levels of damaged red blood cells have to be eliminated from the body, which in turn triggers high bilirubin levels. The baby may be born anaemic and develop severe jaundice within hours of birth.
• Haemolytic anaemia – the inherited types of haemolytic anaemia are autoimmune disorders, characterised by the destruction of red blood cells by the immune system. Haemolytic anaemia can be a complication of other disorders, such as malarial infection.
• Galactosaemia – galactose is a milk sugar. A baby with galactosaemia lacks the enzyme needed to metabolise galactose. The high levels of milk sugar can cause cirrhosis of the liver and subsequent jaundice.
• Biliary atresia – the ducts that allow the flow of bile from the liver to the small intestine are destroyed, for reasons unknown. Without bile ducts, bile accumulates within the liver and causes the characteristic symptoms of jaundice.

Diagnosis of the cause of jaundice 

• The underlying cause of jaundice in babies must be found. Some of the diagnostic tests may include:
• Physical examination
• Blood tests
• Ultrasound scans
• Liver biopsy
• Exploratory surgery.
• Treatment for jaundice

Treatment for jaundice in babies depends on the cause, but may include:

• Mild physiological jaundice – if the baby is otherwise healthy and well, no treatment is necessary. The baby's liver will take only a few days to process bilirubin properly.
• Moderate to severe physiological jaundice – options may include phototherapy (light therapy). This helps to transform the bilirubin in skin into a less harmful chemical. In severe cases, a blood transfusion may be needed, but this is very uncommon.
• Breast milk jaundice – breastfeeding is almost always continued. Phototherapy is usually the primary treatment.
• Neonatal hepatitis – there is no specific medical treatment. Options may include vitamin and mineral supplements, or drugs to improve the flow of bile.
  Haemolytic anaemia – treatment depends on the cause. For example, infection with malarial parasites can cause haemolytic anaemia and treatment includes anti-malarial medications.
• Galactosaemia – the principal treatment is to make sure the baby's diet contains no galactose or lactose (another milk sugar). Typically, this means stopping breastfeeding and necessitates the use of special formulas.
• Biliary atresia – involves surgery to connect a tiny section of the liver to the small intestine to allow bile to drain effectively. Around 75 per cent of patients will experience good to moderate bile flow. For the remainder, the only option may be a liver transplant.

Where to get help

• Your doctor
• The Maternal and Child Health Line is available 24 hours a day Tel. 132 229.

Things to remember

• Jaundice is characterised by a yellowish tinge to the skin and eyes.
• About six out of 10 new-borns have jaundice to varying degrees.
• Jaundice is caused by an excess of a chemical called bilirubin.
• Physiological jaundice will resolve by itself once the baby's liver is functioning at full speed.
• Other causes of jaundice include haemolytic anaemia, hepatitis and galactosaemia.

Source (better health.vic.gov.au)