Author
Dr. Rajeev Tomar
Dr. Rajeev Tomar, MD Paediatrics (India), FRCPCH (UK), CCT
(UK). The author is currently working as Consultant Paediatrician
and Hepatologist at Kings College Hospital London, Dubai and
Abu Dhabi, UAE. Before he moved to the UAE, he worked in the UK
for several years. He also trained in Paediatric Hepatology at
Kings College Hospital London in the UK.
Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes. Across the globe, it can be present in 60% of babies born at term and up to 80% in premature births. It is one of the most common conditions doctors come across when examining new-born babies.
What causes jaundice in babies?
Jaundice occurs when the baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance the body creates when it breaks down old red blood cells. Subsequently, the liver helps to degrade bilirubin further, so it can be eliminated from the body through the stool. Any defect in this process can cause jaundice in newborn babies. The most common type is called physiological jaundice. In rare cases, blood diseases and liver diseases can cause jaundice in babies.
What causes physiological jaundice in babies?
When the baby is in the womb, among other waste products, bilirubin is removed through the body system of the mother. However, once the baby is born, the baby’s liver has to rid the body of bilirubin.
In a newborn, it takes a few more days before the liver is able to function efficiently. Therefore bilirubin may build up in the body. This excess can cause jaundice. By this time the baby is about 2 weeks old, the liver is more effective in processing bilirubin, so jaundice often corrects itself by then without causing harm. This kind of jaundice is called physiological jaundice.
It typically appears as yellowish decolorization first in the face, and then the chest, abdomen, arms, and legs.
How common is physiological jaundice in newborns?
It is very common. 60% of newborns and up to 80% of premature babies will contract jaundice just 2 or 3 days aer birth. However, it doesn’t necessarily mean that the baby is ill..
How is physiological jaundice diagnosed?
Serum bilirubin is a simple blood test that determines total bilirubin levels. Some hospitals also use probes, which provided an estimated level of bilirubin, as they are painless. However, these probes are used in the first week of the baby’s life.
Will physiological jaundice go away?
It normally disappears by the time baby is 10-14 days old. This may take up to 3 weeks if the baby is premature.
How can neonatal jaundice be treated?
Most babies don’t require treatment as jaundice disappears by the time they are 2 weeks old. However, some may need treatment depending on the blood bilirubin levels. In this case, the treatment would be phototherapy, which reduces bilirubin levels. Phototherapy usually solves the problem within a few days. In rare cases, the baby might need a blood transfusion. If levels are high, there is a risk that bilirubin
could cause damage to the baby’s brain (kernicterus). Therefore, it is important that babies with a certain level of bilirubin should be treated promptly. Treatment levels of bilirubin depends on the age and maturity of the baby.
Are there any causes of jaundice in newborns apart from physiological jaundice?
There are rare diseases of the blood and liver which can cause jaundice in newborns. Therefore, It is important to investigate further, especially if the jaundice is prolonged for more than two weeks, or if the baby is unwell and has any other symptoms suggestive of blood or liver diseases. Therefore it is important to see a childcare specialist to make sure that jaundice in your baby is physiological.
What if jaundice occurs within the first 24 hours after birth?
This is rare. If it does, be sure to get a baby doctor (neonatologist)to monitor the baby closely.
What is biliary atresia?
It is a condition where the drainage system of the liver through which bilirubin is drained is completely blocked. The baby is born with it. This can be suspected early by paying attention to the color of the baby’s
urine and stool. Usually the baby’s urine is colorless, and the stool is mustardy yellow or greenish in color. If your baby’s urine is dark yellow and/or the stools are pale/chalky white, this can indicate biliary atresia and the parents must report this to the doctor and should not wait for more than 14 days to pass. Biliary atresia would require urgent surgery. The delay in diagnosis of biliary atresia can lead to severe liver damage ultimately requiring liver transplant. Therefore it is important to diagnose the disease as early as possible.
“It is important that babies with a certain level of bilirubin should be treated
promptly.
