Table of Contents
What is neonatal jaundice?
Neonatal jaundice is the yellowing of the skin, sclera, and the mucous membrane of the newborn baby caused by the accumulation of bilirubin in the blood..
Causes of Neonatal Jaundice
Neonatal sepsis (mostly bacterial infections)
Prematurity: the baby’s liver is not yet mature enough
Delayed feeding, leading to breastfeeding jaundice
ABO and Rh incompatibility: when the baby’s Rh group is different, like the parent is Rh positive and the baby is Rh negative.
Deficiency of glucose-6-phosphate dehydrogenase (G6PD): G6PD deficiency makes red blood cells vulnerable to oxidative stress
Biliary atresia: this prevents the normal flow of bile from the liver to the intestine.
Birth trauma (extensive bruising or cephalohematoma)
Risk Factors for Neonatal Jaundice
neonate born to a mother with diabetes mellitus because of polycythemia and increased red blood cell breakdown, resulting in excess bilirubin production.
birth asphyxia, which causes hypoxia, reducing the liver’s ability to conjugate and excrete bilirubin
increased number of red blood cells; breakdown of the excess red blood cells produces large amounts of bilirubin
Pathophysiology of Neonatal Jaundice
What Happens in Neonatal Jaundice?
Neonatal jaundice develops when the production of bilirubin exceeds the newborn’s ability to metabolize and eliminate it. This results in an accumulation of bilirubin in the blood (hyperbilirubinemia), causing the skin, sclera, and mucous membranes to appear yellow.
Step 1: Increased Breakdown of Red Blood Cells
After birth, fetal red blood cells (RBCs) are rapidly broken down and replaced by adult RBCs. During this process, haemoglobin is converted into heme, then biliverdin, and finally unconjugated (indirect) bilirubin, leading to increased bilirubin production.
Signs and Symptoms of Neonatal Jaundice
yellowing of the baby’s skin, sclera, and the mucous membrane because excess bilirubin accumulates in the blood and is deposited in the skin, mucous membrane and the sclera
poor feeding; baby with jaundice is always lethargic and has a weak suckle.
high-pitched crying a warning sign of severe hyperbilirubinemia
apnea occurs in severe bilirubin toxicity due to depression of the brainstem respiratory centers
hypotonia or hypertonia
Dark urine may occur in conjugated jaundice such as biliary atresia
Types of Neonatal Jaundice
Neonatal jaundice can be classified based on the cause, timing of onset, and type of bilirubin involved. The main types include:
1. Physiological Neonatal Jaundice
Physiological jaundice is the normal increase in bilirubin levels that occurs in many newborns during the first days of life. It occurs because newborns have increased red blood cell breakdown and an immature liver that is not yet efficient at processing bilirubin.
Characteristics:
- Appears after the first 24 hours of life
- Usually reaches its highest level around the third to fifth day after birth
- Usually resolves as the baby’s liver matures and bilirubin clearance improves
2. Pathological Neonatal Jaundice
Pathological jaundice occurs when bilirubin levels rise because of an underlying disease or abnormal process.
Causes include:
- Hemolytic disease due to ABO or Rh incompatibility
- G6PD deficiency
- Neonatal sepsis
- Liver disease
- Disorders affecting bile flow
Features suggesting pathological jaundice:
- Jaundice appearing within the first 24 hours after birth
- Rapidly increasing bilirubin levels
- Persistent jaundice beyond the expected period
- Signs of illness such as poor feeding or lethargy
3. Breastfeeding Jaundice (Suboptimal Intake Hyperbilirubinemia)
Breastfeeding jaundice occurs when a newborn does not receive enough breast milk during the early days of life. increasing reabsorption of bilirubin from the intestine back into the bloodstream.
Risk factors include:
- Poor breastfeeding technique
- Infrequent feeding
- Delayed establishment of effective breastfeeding
Summary Table: Types of Neonatal Jaundice
| Type | Main Cause | Onset |
|---|---|---|
| Physiological jaundice | Immature liver and normal red blood cell breakdown | After 24 hours |
| Pathological jaundice | Disease or abnormal condition | Within first 24 hours |
| Breastfeeding jaundice | Poor milk intake | First week |
| Breast milk jaundice | Substances in breast milk affecting bilirubin metabolism | After first week |
| Hemolytic jaundice | Increased red blood cell destruction | Early onset |
| Conjugated jaundice | Liver or bile duct problems | Variable |
| Unconjugated jaundice | Increased bilirubin production or reduced processing | Common in newborns |
Investigations for Neonatal Jaundice
History taking and physical examination to know whether the jaundice is physiological or pathological.
Liver function tests (LFTs) to check if the cause of jaundice is related to the liver
Bilirubin blood test to measure the amount of bilirubin in a newborn’s blood
Blood group and RH to see the incompatibility with the mother
Direct Coombs test: The Direct Coombs test determines if antibodies bound to the baby’s red blood cells are causing them to break down and release excess bilirubin.
G6PD screening to detect glucose-6-phosphate dehydrogenase enzyme deficiency.
CBC: It helps identify underlying causes of the neonatal jaundice, like hemolytic anaemia, polycythemia, or infection (sepsis)
Direct Coombs test. It detects if the mother’s antibodies are the ones attacking the baby’s red blood cells.
Transcutaneous bilirubin (TcB): A quick skin test using a light meter to screen well babies
Management of Neonatal Jaundice
put the baby on phototherapy
frequent breastfeeding
antibiotic
exchange blood transfusion
Nursing Management of Neonatal Jaundice
Place the baby on phototherapy light to convert bilirubin into water-soluble forms that can easily be excreted
Turn the baby every two hours so all skin surfaces receive adequate exposure.
Feed the baby with expressed breast milk, and if the mother can breastfeed, encourage breastfeeding every 2 hours to 3 hours; it increases stool passage and reduces bilirubin reabsorption from the intestines.
Monitor input and output and use the fluid balance chart, i.e., amount of milk given, urine and stool
Administer antibiotics as prescribed by the doctors, e.g., ampicillin and gentamicin.
Monitor phototherapy light for side effects such as skin rashes, fever, and loose stools.
Monitor vital signs, including temperature, oxygen saturation, pulse, and respirations.
Advise the mother on the importance of breastfeeding frequently because some mothers may feel like distubence
educate the parents on the causes of jaundice, treatment, importance of feeding, and possible complications.
Monitor for Signs of Kernicterus. Observe for convulsions, lethargy, poor feeding, high-pitched crying, abnormal muscle tone, unconsciousness, or other neurological signs, and report them immediately.
Complications of Neonatal Jaundice
Acute bilirubin encephalopathy
Kernicterus
Convulsions (seizures)
Hearing loss
Developmental delay
Intellectual disability
How to Prevent Neonatal Jaundice
Early breastfeeding prevents reabsorption of bilirubin into the bloodstream by washing it from the gut
Antenatal blood grouping: This helps to identify the mother’s Rh factor and ABO type
Rh Immunoglobulin: Administered to Rh-negative mothers to prevent their immune system from developing harmful antibodies against Rh-positive fetal blood cells.
Early Screening: Early detection of abnormalities that can lead to neonatal jaundice and early intervention
Prompt Treatment of Infections: Prevents infection-induced red blood cell destruction.
Frequently Asked Questions (FAQs) About Neonatal Jaundice
1. What is neonatal jaundice?
Neonatal jaundice is a condition in newborns where the skin and eyes turn yellow due to a buildup of bilirubin in the blood.
2. What causes neonatal jaundice?
Common causes include physiological jaundice, breastfeeding jaundice, breast milk jaundice, blood group incompatibility, prematurity, birth bruising, infections, and G6PD deficiency.
3. Is neonatal jaundice normal?
Yes. Especially physiological jaundice
4. What are the symptoms of neonatal jaundice?
The main symptom is yellowing of the skin and the whites of the eyes. Other signs include poor feeding, excessive sleepiness, dark urine, and pale stools in more severe cases.
5. How is neonatal jaundice diagnosed?
Doctors diagnose neonatal jaundice through a physical examination and by measuring bilirubin levels using a skin scanner (transcutaneous bilirubinometer) or a blood test. Additional tests may be performed to determine the underlying cause.
6. How is neonatal jaundice treated?
Treatment depends on the baby’s bilirubin level and age. Mild cases often require frequent feeding, while more severe cases may need phototherapy (blue light therapy), sunlight exposure and rarely, an exchange blood transfusion.
7. Can breastfeeding cause neonatal jaundice?
Yes. Breastfeeding jaundice can occur when a baby is not getting enough milk in the first few days of life.
8. Is neonatal jaundice dangerous?
Physiological jaundice is not, but pathological jaundice is very dangerous
9. How long does neonatal jaundice last?
Physiological jaundice usually resolves within 1–2 weeks in full-term babies. In premature infants or those with breast milk jaundice, it may last 3 weeks or longer.
10. When should parents seek medical attention?
Parents should seek immediate medical care if jaundice appears within the first 24 hours after birth, if the baby is difficult to wake, refuses to feed, has a high-pitched cry, develops pale stools or dark urine, or if jaundice persists beyond 2–3 weeks.
References
Merck Manual Professional Edition — Neonatal Hyperbilirubinemia (Jaundice in Neonates).American Academy of Paediatrics (AAP) — Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Merck Manual Consumer Version — Jaundice in the Newborn.World Health Organization (WHO). Pocket Book of Hospital Care for Children, 3rd edition. Nelson Textbook of Pediatrics.