Infant Jaundice: A Common Complication in Newborns

What Is Infant Jaundice?

Jaundice is a yellowish discoloration of the skin, eyes, sclera, and oral mucosa. It is caused due to excessive production of bilirubin in the blood. Bilirubin is a yellowish pigment seen in red blood cells. Infant jaundice usually occurs in a child born before the thirty-eight-week gestation period. The baby's liver is not developed correctly to remove bilirubin from the bloodstream. This causes excessive bilirubin in the bloodstream resulting in infant jaundice.

Severe jaundice can cause various complications in children, such as brain damage. According to the American Academy of Pediatrics, infants should be examined for jaundice before discharge and between three to five days. If the baby has persistently high bilirubin levels, they are at increased risk of deafness and cerebral palsy.

What Are the Causes of Infant Jaundice?

Following are the various causes of infant jaundice.

• Premature birth of the child before thirty weeks of gestation.

• Newborns who are not getting enough breast milk.

• Newborns who are not able to feed correctly.

• If the blood group of the child is not compatible with their mother.

• Liver problems.

• Infections.

• Abnormality in red blood cells.

• Presence of enzyme deficiency.

• Presence of internal bleeding.

• The problematic delivery causes the presence of cephalohematoma (rupturing of small blood vessels in the fetus due to pressure during delivery).

• Diseases affecting the liver and biliary tract, such as cystic fibrosis.

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• Low oxygen level.

• Genetic and inherited disorder.

• If the child is born with a high red blood cell number in conditions like polycythemia.

What Are the Types of Infant Jaundice?

1. Physiologic Jaundice - In this type of jaundice, the liver is not developed correctly after the child's birth. It causes accumulation of bilirubin due to improper filtration of bilirubin from the bloodstream. When the fetus grows, the placenta helps remove bilirubin from the body. After birth, between two to four days a child, there is the presence of yellowish discoloration. This yellowish discoloration disappears on its own, and the amount of bilirubin should not exceed 200 micromoles per liter.

2. Pathogenic Jaundice - It is caused due to pathology found in the child. It is divided into

• Neonatal Jaundice is seen in the first twenty-four hours of an infant's life. There are various causes of neonatal jaundice, such as rhesus (Rh) disease, incompatibility with the mother's blood, and infections, such as toxoplasmosis, measles, and syphilis. It is also found in glucose six phosphate dehydrogenase deficiency and Crigler-Najjar syndrome.

• Prolonged Neonatal Jaundice - It persists in infants for more than twenty-one days after the child's birth. It is caused by urinary tract infections, hypothyroidism, bile duct problems, and neonatal hepatitis.

What Are the Risk Factors of Infant Jaundice?

Following are the various risk factors for the development of infant jaundice.

• Family history of jaundice.

• Presence of premature birth of preterm infants.

• Lack of malnutrition due to the first few days of the child's birth.

• Presence of low birth weight.

• Presence of family history of blood disorder.

• Presence of bruising during birth.

• Presence of diabetes in mother.

• Presence of incompatibility between the blood type of the mother and the child.

What Are the Clinical Features of Infant Jaundice?

The main sign of jaundice is a yellowish discoloration of the child's skin, eyes, and oral mucosa. The yellowish discoloration is seen after two days of birth. The discoloration is first seen in the face and may spread to the child's whole body. The child's skin becomes pale yellow if the finger is gently pressed to the skin. The yellowish discoloration is evident after three days of birth because the bilirubin level is typically peak.

Following are the clinical features of newborn children who have jaundice.

• The child's skin is yellow after the second day of birth.

• The child is exhausted, and it is not easy to wake the child.

• The child is weak and unable to gain weight.

• Presence of high-pitched cries.

• The child refuses to feed.

• The child is irritable.

• The child has their neck and body in the backward direction.

• The skin below the knees appears yellowish.

What Are the Complications of Infant Jaundice?

The complication of infant jaundice is seen if jaundice persists for more than three weeks, and the high levels of bilirubin results in the following difficulties.

1. Kernicterus - It is a severe complication of persistent jaundice in the child. If the jaundice is persistent and untreated, it can damage the newborn's central nervous system and brain. There is the presence of hyperbilirubinemia, and bilirubin crosses the thin layer of tissue separating the barrier between blood and the brain. It can be a life-threatening condition as it can cause damage to the brain and spinal cord.

Following are the signs and symptoms of kernicterus in infants.

• The child is unable to eat properly.

• Presence of irritability.

• Absence of startle reflex.

• Presence of lethargy in children.

• Presence of apnea (cessation of breath).

• The muscle of the child is floppy like a rag doll.

• Presence of seizures and muscle spasms.

• There is a mild to severe range of hearing loss in the child.

• There is a difficulty in maintaining regular eye movements; the child tends to gaze in an upward direction.

• There is the presence of poor development of the teeth of the child.

2. Acute Bilirubin Encephalopathy - Severe untreated and persistent jaundice may result in a condition known as acute bilirubin encephalopathy. Following are the signs of acute bilirubin encephalopathy.

• The child feels difficulty while waking up.

• There is a presence of listlessness.

• The child has fever.

• There is the presence of cerebral palsy, which affects the child's coordination and movement.

• There is a presence of learning disabilities.

What Are the Treatment Plans for Infant Jaundice?

Following is the treatment plan for persistent infant jaundice.

• Light therapy: It is also known as phytotherapy and bill's light. In this process, excessive bilirubin is excreted through urination of the child with the help of phytotherapy.

• Blood Transfusion: The blood transfusion is done by replacing the child's blood with fresh blood in small amounts.

• Intravenous Immunoglobulin: The child has injected immunoglobulin through a needle into the veins. It helps in avoiding blood transfusion.

Conclusion

Infant jaundice is one of the common complications seen in newborn babies, and it goes away as the baby develops. As the baby grows and starts feeding, the bilirubin passes out of the body. Therefore, parents should not get anxious and worried unless the jaundice is severe. If jaundice persists for more than three weeks, the child should be appropriately examined for the underlying causes, and treatment should be done according to it.