Neonatal Jaundice

Neonatal jaundice is one of several terms used to describe a liver-related condition that sometimes occurs in newborns. Neonatal, of course, is a synonym for "newborn."

A baby with neonatal jaundice experiences a discoloration of the skin and eyes, which begin to look yellow.

Neonatal jaundice is relatively common. Generally, no treatment is necessary. It often appears around the third day after delivery and clears up on its own a few days later.

Sometimes, but not often, neonatal jaundice is a symptom of an underlying problem. As a policy matter, most hospitals will check for jaundice before discharging you.

Although neonatal jaundice can happen to any baby, it happens more often in those who are delivered before the 36-week mark of the pregnancy. At this stage, the baby's liver has not quite fully developed. Very rarely, complications arise that can cause brain damage.

Physical causes

To understand neonatal jaundice, you have to know a little bit about the function of the liver, and about a substance called bilirubin.

Bilirubin is a yellow colored pigment found in red blood cells.

When the baby is still in the womb, it gets oxygen from red blood cells. Since the baby must rely exclusively on red blood cells for its oxygen supply, a lot of red blood cells are produced. Following delivery, fewer red blood cells are needed and excess cells start to break down. A waste product - bilirubin - is produced. This bilirubin is processed through the liver and eventually passes out of the body through stool.

Neonatal jaundice can also result because the infant's liver hasn't matured enough and can't remove bilirubin fast enough. The medical name for this condition is hyperbilirubinemia, but even doctors usually just call it jaundice for simplicity.

In those unusual instances where jaundice is caused by some other condition, the usual suspects are a blood infection, a viral or bacterial infection, liver problems, or internal bleeding

Symptoms

Symptoms of neonatal jaundice are usually pretty obvious. The skin and eyes have a yellow discoloration. This discoloration typically starts in the face, then appears in other parts of the body.

There's a fairly simple way to check if neonatal jaundice is in progress by touching a finger gently to your infant's forehead or nose. If the skin looks yellow where you pressed, your baby probably has jaundice. If jaundice is not present, the skin will look a little lighter for a second or two, but will then return to its normal color.

If a more serious case of neonatal jaundice is developing you'll notice the following (in addition to yellowing).

• Your baby may begin to seem unusually sleepy or difficult to wake.
• He or she may not be gaining weight normally.
• He or she may not be eating normally.
• He or she may make unusually high pitched cries.
• There is a fever.

Treatment

If your baby neonatal jaundice is mild, it will probably go away on it's own in 2-3 weeks. More severe cases may cause the baby to stay in the hospital nursery longer, or, if you've already brought the baby home, he or she may need to be readmitted to the hospital.

There are several things your doctor can do to lower bilirubin levels.

In mild cases, a change in feeding habits may work. Talk to your doctor about these. More frequent feeding may result in more bowel movements, which speeds up the process of removing bilirubin. Your doctor might also suggest using formula or expressed milk to supplement feedings, especially if the infant is losing weight or seems dehydrated.

Other options include:

Light therapy Special lighting is available that changes the shape and structure of bilirubin molecules, making it easier for them to pass out of the body in urine or stool. This process is also known as phototherapy.

Intravenous immunoglobulin This treatment is used when jaundice is caused by blood type differences between the baby and the mother.

Exchange blood transfusion This type of treatment isn't required very often, but may be necessary when other treatments haven't worked. Small amounts of blood are withdrawn, bilirubin and maternal antibodies are diluted out, and then the blood is returned to the infant. This procedure is done in a neonatal intensive care unit.

Neonatal jaundice can be frightening to mothers who don't realize that it's relatively common and generally harmless. Nonetheless, it's important to monitor your baby carefully in the first five days of life to prevent any possibility of complications.

Also see our article on jaundice. 

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