Jaundice in newborns can be found in infants of all races. The cause of the yellow appearance in babies is due to a substance called “bilirubin” in the body. Normally, bilirubin is produced in the bloodstream and eliminated from the body by the liver, which is a natural process.
While the baby is in the womb, bilirubin is eliminated through the placenta to the mother’s liver. After birth, the baby’s liver must take over the task of eliminating bilirubin on its own.
However, since the newborn’s liver is not fully functional during the first 2-3 days, most babies will have noticeable jaundice during this period. The yellowing starts from the face and then spreads to the chest, abdomen, arms, and legs according to the bilirubin level. Some babies may also show yellowing in the whites of their eyes.
Causes of Jaundice in Newborns
Jaundice occurs mainly from 2 causes:
1. Physiologic Jaundice
This occurs because babies in the womb have a higher concentration of red blood cells, and their red blood cells have a shorter lifespan than adults. When the baby’s red blood cells break down and convert to bilirubin more than usual, exceeding the body’s ability to eliminate it, and since the baby’s liver is not fully efficient, bilirubin elimination is incomplete. This causes bilirubin to accumulate in the body. If the baby has no other abnormalities, it can resolve on its own within 1-2 weeks.
2. Pathologic Jaundice
This can be caused by several factors such as blood group incompatibility between mother and baby, found in pairs where the mother has blood group O and the baby has blood group A or B, or where the mother is Rh-negative and the baby is Rh-positive. Babies with red blood cell abnormalities or G6PD enzyme deficiency, which causes red blood cells to break down more easily, or babies with a higher number of red blood cells, especially those born to diabetic mothers.
It mostly occurs in babies who are not fed adequately. Common causes include improper breastfeeding positions or factors related to the baby, such as premature birth, low birth weight, or tongue-tie causing poor breastfeeding.
Other causes include hepatitis, biliary atresia where the baby has jaundice along with pale stools, hypothyroidism, bloodstream infections, etc.
Severity of Jaundice in Newborns
If bilirubin levels are too high, it can cross into the brain and deposit in brain tissue, causing brain damage called Kernicterus. Early symptoms include lethargy, weakness, and poor sucking. Later stages show increased lethargy, irritability, fever, high-pitched crying, muscle stiffness, neck arching backward, and back arching.
If treated early with blood exchange, permanent brain damage can be prevented, reducing the severity of brain disability. Without treatment, symptoms worsen with increased neck and back stiffness, refusal to feed, seizures, apnea, and can lead to death.
Self-resolving Jaundice in Newborns
Most jaundice improves after the baby is 1 week old and resolves within 1 month. Generally, this condition does not harm the baby unless bilirubin levels are very high, which may affect the baby’s brain.
Babies who are not fed enough and lose significant weight have a higher chance of jaundice. Therefore, breastfeeding should be done at least 8-10 times a day initially to stimulate milk production and help reduce jaundice in the baby.
Since breast milk is an important food for the baby, if there are breastfeeding problems, please consult a neonatologist, nurse, or breastfeeding specialist.
Treatment of Jaundice
Jaundice can be treated by
1. Phototherapy
Using special lamps that emit blue light with an appropriate wavelength. During phototherapy, the baby’s clothes must be removed, eyes covered, and the doctor will periodically check blood bilirubin levels until they decrease to a safe level. Side effects of phototherapy may include dehydration and weight loss due to increased water loss from the body. Taking the baby out in the sun does not reduce bilirubin levels or jaundice.
2. Blood Exchange
In cases where bilirubin levels are too high and do not decrease with phototherapy, blood exchange is necessary to prevent bilirubin from depositing in the brain (kernicterus). This involves removing the baby’s blood with high bilirubin and replacing it with donor blood. This is done when bilirubin levels are very high or when the baby shows neurological symptoms to rapidly reduce bilirubin levels.
3. Treating the underlying cause of jaundice
How to Observe if Your Baby is Jaundiced
Some babies clearly show yellow eyes and skin, but there is a simple way to check:
Place the baby in a well-lit room with white light. Press your finger on the baby’s skin or use your thumb and index finger to press and separate the skin to squeeze blood out of the capillaries in the area to be checked. Observe the color that appears. Normally, it will appear white, but if it appears yellow, especially if the yellow extends to the legs or shins, you should take the baby to see a doctor immediately.
