The ‘Yellowing’ that is a ‘red light’

                                    Neonatal Jaundice                                       

If you have ever visited a newborn baby unit, you would have seen some babies kept under special devices emitting a blue light. You may have heard that this is a form of treatment for a condition called neonatal jaundice. Not only does neonatal jaundice rank high among the complications occurring in newborn babies, it has the potential to cause significant adverse effects later in life. At times, it also acts as an early warning sign of more severe underlying pathologies. The health capsule decided to consult Dr. Deepal Perera, Consultant Paediatrician, Apeksha Hospital Maharagama, to obtain more information regarding this condition.

About Neonatal Jaundice

A person is said to have jaundice when he or she has yellowish discoloration of the skin and in the white part of the eye, due to the accumulation of a substance called indirect bilirubin in the blood. Indirect bilirubin is produced as a result of a breakdown of blood cells in our body, and cannot be excreted directly. These particles are then transported into the liver and converted to another form of bilirubin, which can be excreted through urine and feces. 

Neonatal jaundice is when the baby is having jaundice within the first month of its life. Functions of the liver are not fully developed in newborn babies, so they do not have the same capacity to turn insoluble indirect bilirubin into the more excretable form, so even a relatively small amount of bilirubin can get accumulated in their blood, causing neonatal jaundice. This process, which is called physiological jaundice, can occur even in normal, otherwise healthy babies, explains Dr. Perera. “This is due to the relatively short lifespan of red blood cells of a neonate, causing them to breakdown earlier, resulting in accumulation in bilirubin”, he explained

But, jaundice can be a presenting feature of a more sinister underlying cause as well. Infections, congenital metabolic conditions and a group of conditions called haemolytic disease of the newborn can also present as jaundice, as a result of increased blood cell breakdown caused by these conditions.

So how do we differentiate physiological jaundice from its more sinister counterpart, which is called pathological jaundice? Physiological jaundice usually appears around second or third day after birth, with blood bilirubin levels going up until around 5th day of birth and going down usually by 10th day following birth.  Therefore, jaundice that appears during the first 24 hours after birth, as well as after 14 days of birth is considered more dangerous, according to the doctor. But this does not mean that all newborns having jaundice between 2nd day and 14th day are having physiological jaundice.

In cases of persisting jaundice after two weeks, thyroid assessment should be done and thyroid hormone supplementation should be started immediately if needed

Pathological Jaundice

Pathological jaundice that appear very early in life can be caused by infections at birth, as well as a condition called haemolytic disease of newborn, which occurs due to incompatibility of the blood between mother and the fetus. In this condition, antibodies produced in the blood of the mother is passed into the blood of the baby, attacking the cells in the blood. This condition is especially seen in Rh negative mothers, who are having Rh positive babies. This can also be seen at times in mothers with the blood group O and babies having blood group A or B. Poor feeding due to various causes like poor feeding technique, difficulty in breastfeeding in prematurely born babies is also a cause of neonatal jaundice. 

If jaundice persists after 2 weeks of birth, it can be due to an underlying condition like congenital hypothyroidism, conditions like congenital biliary atresia, choledochal cysts, or underlying infections, which needs early recognition and intervention.

Complication of Neonatal Jaundice

Why are we so concerned about jaundice in newborns, we asked the doctor. This is because of the long-term effects that the baby can have later in life due to accumulation of bilirubin in blood, he explains. In adult brain, there is an obstacle called the Blood Brain Barrier covering the blood vessels supplying the brain which filters blood of unwanted material before delivering it to the brain. Like many organs in a newborn’s body, the blood brain barrier is not fully developed at birth. Therefore bilirubin, when it passes a certain level in blood, goes directly into the brain and gets collected in the brain tissues, giving rise to a condition called kernicterus. 

Kernicterus can give rise to many complications related to brain development like cerebral palsy and learning disabilities in children. Therefore timely management of both physiological and pathological jaundice is of utmost importance. In addition, as explained earlier, underlying causes in case of pathological jaundice need to be identified and treated immediately.

Treatment for neonatal jaundice

Neonatal jaundice can be successfully treated with no lasting consequences if identified early and managed, emphasises Dr. Perera. The need for treatment is decided after checking the baby’s blood levels of bilirubin. In cases of very high levels of bilirubin, a procedure called exchange transfusion is performed. There, the blood which contains toxic amounts of bilirubin is replaced with normal blood. 

In newborn babies with moderate levels of jaundice, phototherapy is the recommended treatment method. Phototherapy is a treatment where the bilirubin in blood is broken down into soluble particles by a special light and excreted through baby’s urine. Keeping as much area of the baby’s skin exposed to the light, (except for the eyes which should be kept covered) is important in receiving the maximum benefit of treatment. Duration of the phototherapy needed will be decided by the level of bilirubin in blood. 

In addition, causes for jaundice should be identified to find out if it’s correctable. Breastfeeding technique should be assessed and corrected, and appropriate antibiotics should be given in case of an infection.

Neonatal hypothyroidism is an important correctable cause of neonatal jaundice. In cases of persisting jaundice after two weeks, thyroid assessment should be done and thyroid hormone supplementation should be started immediately if needed. Thyroid deficiency at birth, if untreated, can cause many adverse consequences like growth retardation and learning disabilities in children. Babies with conditions like congenital biliary atresia and choledochal cyst should be referred to a paediatric surgeon because they are likely to have to undergo surgery.

Message to the parents of newborns

Neonatal jaundice is a common condition occurring in newborn babies. Even though it can have adverse effects if untreated, timely identification and treatment will result in complete cure for the baby. Therefore knowing about the condition and the modes of treatment is important in parents of newborn babies. Also, seeking medical advice in case of suspicion of yellowish discoloration of the skin of your newborn, especially after 2 weeks following birth, will help in preventing complications, ensuring the health of your baby.

If you have ever visited a newborn baby unit, you would have seen some babies kept under special devices emitting a blue light. You may have heard that this is a form of treatment for a condition called neonatal jaundice. Not only does neonatal jaundice rank high among the complications occurring in newborn babies, it has the potential to cause significant adverse effects later in life.