What you need to know about Neonatal Jaundice

Neonatal jaundice is the yellowing of the eyes or the skin of your baby. It results from an increase in bilirubin in the baby’s bloodstream. Bilirubin is released from red blood cells when they are broken down. Red blood cells carry oxygen to the organs of the body. There are two types of bilirubin: direct and indirect. A high level of indirect bilirubin in the blood may result in bilirubin entering the brain and causing brain damage.

What are the causes of neonatal jaundice?
In most babies, jaundice is a common and normal event. Jaundice usually appears on the 3^rd or 4^th day of life but disappears after the first week. This is because newborn babies have a large number of red blood cells, which are quickly broken down. This leads to the release of bilirubin into the blood that is then cleared away by the liver. In newborn babies the liver is still immature and is not able to handle the larger amounts of bilirubin very well.

Babies are also more likely to develop jaundice if they are not breastfeeding well so it is important that mothers are encouraged to breastfeed their new babies as much as they are able to take.

Sometimes the level of bilirubin can become very high and this becomes dangerous to the baby. Jaundice that appears during the first 2 days of life is always abnormal and these babies must be seen by a doctor as soon as possible.

Causes of abnormal jaundice include:

• Blood group incompatibility (Rhesus or ABO): This means that there is a difference between the blood group of mother and baby which can sometimes lead to jaundice in the baby
• Infections
• G6PD deficiency: G6PD is a chemical that is normally present in red blood cells in a certain quantity. Some babies (much more common in boys) are born with reduced amounts of this chemical or it may be totally absent. Exposure to substances like camphor or drugs containing sulphur can trigger jaundice in such babies.
• Prematurity: babies born before 9 months of pregnancy
• Problems or blockages in the liver

Jaundice that lasts for more than 14 days is also abnormal and such babies must also be seen by a doctor. Jaundice is not caused by spiritual forces, bad blood or by too much oil consumption by mother during pregnancy.

How do we pick up jaundice in babies?
Visual inspection can be helpful to detect jaundice in babies. This is done on a naked baby in bright and preferably natural light. The eyes, (white of the eyes), gums and blanched skin are examined for yellow discoloration.

At the hospital, once the jaundice is suspected, blood tests will be done to check the level of bilirubin. Other tests may be requested to find the cause of the jaundice.

Should you be worried if your baby has jaundice?
Jaundice, if not treated on time, can damage to your baby’s brain.

Initially, your baby may develop one or all of the following: fever, refusal to eat, weakness, abnormal arching of the back and neck, down turning of the eyes or convulsions. If nothing is not done at that point, your baby may die or develop handicaps later in life such as cerebral palsy, hearing problems or convulsions.

No one can really say exactly when and at what level of jaundice brain damage will definitely occur. When you notice that your baby’s eyes are yellow or you blanch the skin and there is yellowish discoloration, you should immediately seek medical attention. The health professional will decide after assessing your baby whether treatment or further investigations are necessary. Ideally all babies with jaundice must have the bilirubin levels tested.

Do not waste time at a prayer camp or church. Do not expose your baby to sunlight, give your baby glucose water or treat your baby with other home remedies. Every minute counts. Seek medical advice immediately.

How is neonatal jaundice treated?
At the hospital, your baby may be put under a blue light (phototherapy), which is a safe and effective way to treat mild to moderate jaundice.

If the level of bilirubin is very dangerous or your baby is very ill, doctors will do what is called an “exchange blood transfusion” where the babies’ blood is exchanged with donor blood in order to remove as much of the bilirubin as possible. Depending on the cause of the jaundice, doctors will add other treatments.

 Jaundice is very common and is best detected in bright light. Jaundice is usually not dangerous and very easily treatable if it is recognized and treated early.

Babies who are kept indoors especially in dark rooms are more likely to have jaundice that is not detected early enough. It is advisable that you examine your baby in good bright light every morning so that any jaundice can be recognized early.