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Neonatal jaundice occurs in 60-80%. of all newborns. It is more common in premature babies. Jaundice occurs in the first 2-3 days of life.
When a baby is born, it begins to breathe through the lungs. The large number of erythrocytes in the fetal blood that carried oxygen when the baby was in the womb is no longer needed and they begin to break down. During its breakdown, increased amounts of bilirubin are formed, a yellow bile pigment, which can cause the baby’s skin to turn yellow.
“The liver is responsible for the processing of bilirubin, but in the first week it is not mature and the liver enzymes are less mature and active, so it is impossible to process this pigment”, says S. Narbutienė.
Yellow species
Jaundice is divided into physiological and pathological. Physiological jaundice occurs in 2-3 days of life, is most active in 4-6 days, and then begins to disappear. It is true that the incidence of jaundice in premature and premature babies can be different: it lasts about a week for premature babies and two for premature babies.
“Jaundice has its order as it occurs. It appears first in the face area and then descends towards the chest, torso, abdomen and finally the extremities. It disappears in the opposite direction, from the extremities. At the latest, it disappears from the face. It is not necessary to treat physiological jaundice ”, says the neonatologist.
If a newborn turns yellow on the first day of life, it is most likely pathological jaundice and doctors should look for the cause of the condition.
“It just came to our knowledge then. One of the most common may be hemolysis, which may be due to a discrepancy between the blood and rhesus factors between the mother and the newborn. This happens when the mother has a negative rhesus blood factor and the newborn has a positive blood factor.
Jaundice is now less common for this reason, as rhesus factor-negative mothers are being evaluated and given anti-D immunoglobalin at 28 weeks’ gestation. As a result, we see less of these jaundices. In Lithuania, the incidence of this reason is 1.6 / 1000 newborns.
The most common jaundice may be due to a lack of identity of blood groups. If the mother’s blood type is O and the newborn’s is A or B, more severe jaundice may also occur due to hemolysis. We see these newborns more often and the incidence is 11.2 / 1000 newborns, – says S. Narbutienė.
The doctor says that if jaundice is caused by blood rhesus factors, then it can be predicted before the baby is born, but jaundice due to a blood type mismatch can only be detected after birth by testing the umbilical cord blood. of the newborn.
“Mothers who have a negative rhesus blood factor and have delivered a newborn with a positive RhD factor should check if they have been given anti-D immunoglobalin within 72 hours of delivery. This is very important if a woman is planning more deliveries so that the fetus does not have a hemolytic disease, ”he says.
Other causes of jaundice
Other reasons that jaundice can occur in the first days of a baby’s life are the identities of other antigenic systems, as well as enzyme deficiency, hereditary spherocytosis, and congenital infection.
“The most dangerous congenital infections for a child, such as toxoplasmosis, cytomegaly, rubella. In the consultation, women are examined for these diseases. In addition, all other infections can give the newborn a more pronounced jaundice, which already needs to be treated, ”says the doctor.
Bruises on the baby’s face or a hematoma on the head with pooled blood can also make the baby’s skin become more pronounced. It is also possible that the newborn’s blood is very thick, so jaundice intensifies when the required amount of fluids is not obtained.
“Special attention should be paid if jaundice lasts more than 21 days. There can be several reasons for this: infection, hypothyroidism, intestinal obstruction, it can also be due to breast milk. When jaundice persists, a bilirubin test should be performed on a newborn to determine what fraction of bilirubin is elevated.
If it is due to hepatitis, bile duct obstruction, or bile duct development, there is an increase in direct bilirubin, the urine is dark, and the stools are clear, clay-like.
The liver and spleen may be enlarged. These newborns must be hospitalized and carry out the necessary examinations: ultrasound of internal organs, liver enzymes, other necessary examinations and start treatment ”, says S. Narbutienė.
Breast milk jaundice
Jaundice can also become more pronounced due to breast milk. For this reason, jaundice is not dangerous for the baby’s health. 10 percent of breastfed newborns may have jaundice for up to 1 month.
“There are two types of breast milk jaundice: one of them can occur in the first 72 hours for a newborn, it is jaundice in lactation. Some newborns receive less food in the first few days, there is a greater weight loss. The newborn does not get enough fluids and calories, which can lead to more pronounced jaundice.
At first glance, this cause is not visible, but after weighing and evaluating the diet, the cause becomes clear. To cure this jaundice, sometimes it is enough to adjust the diet, change the breastfeeding position, and usually the jaundice does not last long. Prevention of hyperbilirubinemia is frequent feeding of the newborn 8 to 12 times a day, especially in the first days.
Other reasons are not entirely clear. It is sometimes associated with a mutation in a gene or with the presence of certain substances in breast milk. However, most of the time the bilirubin level does not grow so fast and if the baby is in good condition, no special treatment will be necessary ”, says the neonatologist.
However, if the baby becomes very yellowish, parents should pay attention to the baby’s feet and palms, as if they were very yellowish, this may indicate a significant increase in bilirubin and the baby should be examined by a doctor who decide if the baby needs treatment or follow-up.
When does jaundice become dangerous?
Although most cases of neonatal jaundice are not dangerous to the baby’s health, there are certain amounts of bilirubin that can irreversibly affect the baby’s brain.
“After assessing the newborn’s age, gestational age, and blood bilirubin levels, we decided if the newborn can be monitored and no treatment is needed at this time, or if phototherapy or even a blood transfusion is needed. encephalopathy, cerebral jaundice.
This usually occurs when bilirubin reaches the range of 425 to 510 µmol / L. The risk limit for premature infants is 340 µmol / l. In such cases, bilirubin can damage the brain and cause necrosis, ”says the doctor.
S. Narbutienė warns when he notices that after a while the newborn acquires a yellow skin tone and does not decrease, and the baby himself becomes slow, sleepy, eats less; it is necessary to investigate, because irritability, increased muscle tone and brain screaming. brain.
“It is best to see your child in natural light, because the light from the lamps can give him a different skin tone than he really is,” said the doctor.
He also advises parents who are concerned about the health of their children to always consult doctors who will examine the newborn. This is especially important for parents who have had their first child and are not yet very experienced with childhood illnesses.
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