Symptoms, Pathology & Treatment of Jaundice in the New Born
Jaundice occurring in the newborn is referred to as neonatal jaundice. It is quite common, usually harmless and resolves in two weeks (physiological jaundice). If it is severe and prolonged, it may be pathological, requiring further investigations to find the cause.
It is characterised by yellowish discoloration of the skin and eyes due to accumulation of a toxic pigment called bilirubin in the blood. Jaundice per se is not a disease but a symptom that may signify an underlying disease.
Approximately 60% of term babies and 80% of preterm babies develop jaundice.
Bilirubin Formation and Excretion
One of the important sources of bilirubin in the body is when red cells are broken down due to aging of the cells when they are replaced by new red cells from the bone marrow. The bilirubin from red cell breakdown is processed in the liver and excreted from the body.
Physiological Jaundice
•The most common cause of neonatal jaundice is physiological jaundice.
•This occurs because newborns have more red cells than adults and hence more is broken down.
•Additionally the newborn liver is immature and unable to handle the increased amounts of bilirubin being formed.
•This results in accumulation of bilirubin in the blood with symptoms of jaundice.
The physiological jaundice described above usually presents between day 2 – 4 after birth, peaks at one week and gradually resolves spontaneously in about two weeks.
Pathological Jaundice
In some cases however, jaundice is caused due to some serious underlying disease of the blood or liver. This is termed pathological jaundice. It is important to recognise and treat pathological jaundice in the neonate promptly because high bilirubin levels in the bloodstream (hyperbilirubinemia) can result in deposition of bilurubin in the brain with serious consequences.
Causes of Pathological Jaundice
Features of Pathological Jaundice
Risk factors of developing Neonatal jaundice
Diagnosing Neonatal Jaundice
Neonatal jaundice is usually evident on physical examination. However, it may be difficult to discern on darker skin and when there is an index of suspicion, a blood test is done to measure bilirubin levels.
Some centres initially measure bilirubin using a device that measures bilirubin levels through the skin (transcutaneous screening). When the bilirubin value on transcutaneous measurement exceeds a certain value (250 micromol/L), blood testing may be done to measure bilirubin levels and confirm the diagnosis.
Tests to determine the cause of pathological jaundice
Once the diagnosis of pathological neonatal jaundice is established, other tests may be required to determine the cause of hyperbilirubinemia.
Other Tests
Physiological jaundice presenting a few days after birth has to be monitored by measuring serum bilirubin regularly and if it is not severe and gradually resolves over the next few days it may not need any treatment.
Treatment of pathological neonatal jaundice depends on the following:
The Treatment Modalities:
Phototherapy
Exchange transfusion
In exchange transfusion, a part of the baby’s blood is removed and replaced with matching blood transfusion. Bilirubin levels above a certain threshold level necessitates exchange transfusion. This is essential to prevent adverse effects of bilirubin toxicity on the brain.
This article was contributed by Lakshmi Venkataraman. MD Pathology