How to protect your newborn from neonatal jaundice

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Neonatal jaundice refers to the yellowish discoloration of the skin and sclera of the eyes in a newborn. High bilirubin level ( hyperbilirubinemia) is the main cause behind it. It may be seen within 0 to 7 days in early neonates and 7 to 28 days in late neonates.

 

There are 60% of term newborns and 80% are preterm suffering from this. Although the types of neonatal jaundice are different from one another. but, the causes are the same. so, the American Academy of Pediatrics (AAP) recommends that all newborn babies be examined for jaundice before discharge from the hospital and again when the baby is between 3 and 5 days old.

 

What are the types of neonatal jaundice?

 

Mainly, there are two types of neonatal jaundice ;

  • pathological jaundice
  • physiological jaundice

Both types vary according to their onset, level of bilirubin in the blood as well as treatment modalities.The graph shows the thresholds for phototherapy. Total bilirubin was plotted against age in hours. The groups of GA were represented with different lines.

sources from researchgate.net

Pathological jaundice

 

In pathological jaundice, the onset is within 24 hours of life in the baby. Here the serum bilirubin level is more than 15mg/dl. And pathological jaundice may occur due to the early hemolysis of RBC. So, the treatments are like exclusive breastfeeding, phototherapy, and exchange blood transfusion.

Physiological jaundice

 

Physiological jaundice mainly occurs after 24 hours of life in a full-term baby. And after 48 hours in the pre-term baby. Therefore,  Phototherapy is the only treatment for this kind of neonatal jaundice.

 

In term baby, physiological jaundice occurs on the 3rd day of life and it reaches the peak on the 5th day of life.  And also gets subsided by the 7th day of birth.

 

Like that in preterm babies, the onset is the 2nd day of life. It reaches the peak on the 7th day. The indirect bilirubin level is about 6-7 mg/dl. Lastly, neonatal jaundice in preterm gets subsided by 14 on the day of birth.

 

Risk factors 

 

J = jaundice within first 24 hours of life

A =a sibling who was jaundice as the neonate

U = unrecognized hemolysis

N = nonoptimal sucking

D = deficiency in G6PD

I = infections

C = cephalohematoma

E = east Asian people

 

Etiology of neonatal jaundice

 

Causes of physiological jaundice

 

  • The causes of physiological jaundice are due to the increased production of bilirubin as well as the increased destruction of erythrocytes.
  • Decrease the level of excretion because of the low amount of ligandin in the liver.
  • In addition to that, the action of bilirubin conjugating enzyme UDPGT(uridine dispho glucuronyl transferase)becomes low. 

Causes of pathological jaundice

 

  • Hypothyroidism
  • Blood group incompatibility
  • Rh factor is a condition that can also occur if the mother has Rh -ve blood and the baby has Rh +ve blood.
  • A urinary tract infections
  • Cholecystitis
  • Inherited enzyme deficiency of glucose 6 phosphate dehydrogenase

Other causes include;

 

  • Internal bleeding at birth
  • Liver problems
  • Infections
  • Enzyme deficiencies 
  • Abnormal destruction of erythrocytes in the baby

How can we clinically assess neonatal jaundice?

 

To assess neonatal jaundice clinically, we can use the KRAMER’S STAGING. Here we can calculate the bilirubin level as per the area of the body. A table is given below to calculate the bilirubin level in the neonate.

Modified Kramer's scale.

sources from https://www.researchgate.net/figure/Modified-Kramers-scale_fig1_331316266

Diagnostic evaluations for neonatal jaundice

 

  • A physical examination can be done within 72 hours of being born to check out neonatal jaundice.
  • At home, you can look out for the yellowish discoloration of the skin and sclera of the eyes.
  • Also, check the baby’s urine and stool. In jaundice, the color of urine becomes yellow which should be colorless and stool is pale.
  • Gently press the tip of the nose and forehead of the neonate to detect jaundice.
  • A skin test is done with a device called a transcutaneous bilirubin meter.
  • Complete blood count
  • Direct serum bilirubin test
  • Total serum bilirubin test
  • Liver function test
  • Osmotic fragility test
  • Glucose 6 phosphate dehydrogenase screening
  • To detect the increased red blood cell count, do a coombs test

Treatment

 

The mild neonatal jaundice can go away after 1 to 2 weeks on its own. But, the mother has to give breastfeeding more often. If not then give the supplementary feeding.

  • Maintain the hydration level of the baby’s body. Because dehydration leads to an increased bilirubin level.
  • Give phototherapy, mainly recommended blue light therapy.
  •  
  • In severe cases, moreover, exchange the neonate’s blood by blood transfusion to replace the damaged blood cells with the healthy ones.

  

 

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