What is Jaundice?
Jaundice in newborn infants and is a clinical sign of excess bilirubin (hyperbilirubinaemia). It is characterized by a yellow coloring of the infant’s skin and other tissues caused by high levels of circulating bilirubin due to the breakdown of red blood cells. There is a 60% incidence of jaundice in full term infants (1st week) and 80% incidence in preterm infants.
Pathophysiology of Jaundice:
During red cell breakdown, hemoglobin is converted into bilirubin and removed to the liver. Bilirubin is water soluble and is excreted by the liver. However unconjugated bilirubin is not water soluble and it cannot be excreted by the liver and it is toxic to the body in high levels. Physiological jaundice is due to a high level of unconjugated bilirubin together with an immature liver which causes a build up of unconjugated bilirubin in the blood (hyperbilirubinaemia). Bilirubin is pigmented which causes a yellowing of the infant’s skin and tissues. A low level of bilirubin is usually not a concern as most infants will experience a certain amount of physiological jaundice which results in no problems. However, if unconjugated bilirubin levels rise rapidly above a safe level and are left untreated the bilirubin can cross the blood-brain barrier and be deposited in the brain stem (basal ganglia) and cerebellum, disrupting cellular metabolism causing irreversible brain damage (bilirubin encephalopathy) leading to kernicterus.
Causes of Jaundice
Physiological Jaundice: Occurs in 60% of term and 80% of preterm infants. The newborn has a high level of haemoglobin combined with a short red cell life leading to a high rate of hemolysis whilst the body mass bilirubin production is more than double in the neonate. This combined with other physiological changes that occur during transition from intra to extra-uterine life can force bilirubin to be processed at a challenging rate for the newborn. Jaundice usually occurs at 2-3 days of life and has resolved by 7-14 days of life. Breastfeeding Jaundice: Occurs in 5-10% of newborns when the infant does not drink enough breast milk and is similar to physiological jaundice but is more pronounced. The mother may require assistance with breast feeding.
Breast-Milk Jaundice: This occurs in 1-2% of breast fed infants and is caused by a substance that is produced in the breast milk. Enzyme activity in the infant’s liver, slows the breakdown and secretion of bilirubin. Jaundice starts at 4- 7 days of age and can last 3-10 weeks (occasionally up to 16 weeks). Breastfeeding does not need to be discontinued as there are no recorded cases of kernicterus resulting from this cause. The infant should however continue to be monitored for signs of improvement / worsening jaundice.
ABO Blood Group Incompatibility and Rhesus Incompatibility (Haemolysis): These can occur if the mother produces antibodies that destroy the newborn’s red cells, resulting in hemolysis of the infant’s blood. This leads to a sudden build up of bilirubin in the infant’s circulation during the first 24hrs of life. ABO incompatibility is less severe than Rhesus Incompatibility, however both varieties present with the most serious type of jaundice.
Also Other Pathological Causes: i.e. sepsis, endocrine /metabolic disorders, bile duct obstruction, G6PD deficiency.
Signs and Symptoms of Jaundice
Yellowing of skin colour, soft palate and sclera of eyes
Dark or grey stools
Jaundice is usually observed in the face and progresses gradually to the trunk and extremities. Therefore a thorough examination in bright natural light should be carried out where possible to determine the extent of jaundice.
Risk Factors for Jaundice
Prematurity (under 38 weeks gestation)
Previous sibling with neonatal jaundice requiring phototherapy
Exclusive breast feeding
Visible jaundice within 24 hours
Diagnosis of Jaundice
A serum bilirubin level will be used in conjunction with signs and symptoms of jaundice. Your doctor will determine if your baby has Jaundice and what actions are needed to treat your baby.
Treatment of Jaundice with a ‘Biliblanket’
The Biliblanket has been in use since 1990 and is an effective and safe method of treating phototherapy. A fibre optic light source is transmitted via a cable which delivers a high intensity of uniform light (blue halogen) only and there is no ultraviolet light. The potential complications of conventional phototherapy are minimized.
Advantages of the Biliblanket
• Infant can be held with no discontinuation of treatment
• Can be nursed in cot instead of incubator
• Encourages infant/maternal bonding
• Reduced heat/electrical dangers compared to overheat phototherapy
• Reduced insensible water loss compared to overheat phototherapy
• Blanket more flexible/comfortable
• Compact and easily transported