Jaundice in newborns, especially in the first week after birth, is normal. It is caused by the buildup of bilirubin, a yellow substance created by the body as it breaks down red blood cells. The treatment to reduce bilirubin levels must be carried out immediately to prevent brain damage.
- The newborn that becomes jaundiced within 24 hours of birth.
- The newborn that becomes visibly jaundiced before going home.
- The newborn with a sibling who had jaundice.
- The newborn born at 35 to 37 weeks of gestation.
- The newborn who is exclusively breastfed.
- The newborn with bruising or bleeding in the brain (cephalhematoma).
- Male newborns.
*** If there are several risk factors at the same time, the risk of jaundice increases. ***
Types of Newborn Jaundice
- Physiological (normal) jaundice is found in more than half of all newborns and usually does not require treatment, except in premature infants who present with coexisting illness.
- A newborn’s liver is not yet fully developed and thus bilirubin removal is slow, leading to jaundice that usually appears on the second to fourth day after birth and which disappears on its own by 1-2 weeks after birth.
- A newborn’s body usually produces twice as much bilirubin as older children and adults as their red blood cells have shorter lifespans.
- Pathological jaundice
- Overproduction of bilirubin
- Hemolytic disease of the newborn (HDN) occurs when the mother’s blood group is different from the baby’s, causing the mother’s body to create antibodies against her baby’s blood. These antibodies can pass to the newborn and destroy their red blood cells. ABO incompatibility is the most common type of hemolytic disease of the newborn (HDN) found in Thailand. It occurs when a mother’s blood group is O and her baby’s blood group is B. Rh incompatibility is rare and currently occurs less and less in the West due to the Rh immunoglobulin that is given to the mother within 72 hours of birth.
- Abnormality of the covering of red blood cells, shortening their lifespans.
- Abnormality of the red blood cells, making them prone to breaking, which can be caused by a number of conditions, including G6PD (glucose-6-phosphate dehydrogenase) or pyruvate kinase deficiency.
- Excessive internal bleeding, such as bleeding in the brain or intestines, causing a higher than normal level of bilirubin.
- Increased absorption of bilirubin by the intestines due to certain circumstances, including:
- The newborn is not able to breastfeed adequately/well.
- Intestinal obstruction, causing bilirubin to be retained and a higher amount is then absorbed into the liver.
- Diminished ability of the liver to process bilirubin
- Infection in utero, such as cytomegalovirus (CMV), Toxoplasmosis, German measles, herpes simplex, syphilis, and hepatitis.
- Premature babies.
Signs and Symptoms
- Breastmilk jaundice
- Yellow skin is usually first noticed at the face, especially if you press down on the forehead. Premature infants have thinner skin and the yellow is more obvious than in full-term infants with the same bilirubin levels. As the bilirubin levels rise, the yellowing will move down to the body and limbs respectively, as seen in the image below.
- Bruising along the body or bleeding at the skin in certain spots. Listlessness, if bilirubin is very high.
- Enlarged liver or spleen, found in hemolytic disease of the newborn (HDN) or in the newborn with intrauterine infection.