Jaundice is common amongst full-term babies when they are born. It is estimated that almost 60% of the children get jaundice after one or two days of being born. It is recognized by a faint yellow shade seen in the baby’s skin and eyes. Doctors advise against unnecessarily worrying about jaundice in newborns as it is harmless. It is considered the body’s natural response after birth. It is, however, of worry when the child is born before the due date. Let’s move on to learning about the causes of pre-term jaundice.
What are the Causes of Jaundice in Neonates?
For pre-term infants, jaundice should be a cause of concern. Jaundice is caused by increased levels of ‘bilirubin.’ This is a pigment that is present in the blood when extra red blood cells are broken down in the body. This substance is sent to the liver where it is broken down and excreted out the body through the stool. For premature babies, the risk factor is automatically higher as compared to children born at full term. The following are the causes of jaundice in premature infants:
- Bilirubin levels: Neonates often have higher levels of the substance in their blood as their liver is not fully developed because of early birth.
- Pre-term birth: The unborn fetus can be virally infected which results in pre-term birth.
- Health complications: Neonates are prone to suffer from various health problems such as respiratory diseases or sepsis which can increase the intensity of jaundice.
- Incompatible blood type: Infants whose blood type is incompatible with their mother results in antibodies produced causing an excessive breakdown of red blood cells and increasing bilirubin levels.
- Abnormalities: Deficiencies of enzymes can also increase the chances of jaundice.
- Genetic: Some infants are more at risk if any of their siblings were diagnosed with similar issues at the time of birth.
- Unintentional bruising: Using instruments while forcing delivery can accidentally cause the skin to bruise.
- Delayed excretion: If there are delays faced in the passing of the first stool after birth, it can cause a risk of jaundice.
What are the Symptoms of Jaundice in Neonates?
The best way to tell whether a baby has jaundice is from the color of its skin. As mentioned, bilirubin’s shade is yellow. Thus, the most common symptom amongst babies is the faint yellow shade observed on their skin and scleras. This tint in the skin usually develops after 3 days of birth. Bilirubin levels are at their highest after a week of birth and this is when the child would look the ‘yellowest.’
As pre-mature births are accompanied by other health problems, it is best to monitor symptoms to prevent them from getting worse. If Jaundice persists longer than 10 days, it can cause a dangerous build-up of bilirubin in the blood. This substance can travel to the brain and cause damage resulting in a condition called kernicterus. This condition is severe and causes life-long ailments such as deafness, muscle defects, neurological impairment, and in extreme cases, death. If any of the following symptoms are observed, immediate medical assistance is required:
- High fever crossing 100 degrees
- Deepening and spread of the yellow tint throughout the body
- An unusual amount of tiredness observed
- Disturbance in the sleeping pattern
- The body is seen to be stiff or limp
- Excessive crying and restless body
- Abnormal eye motions
- Unusual muscle movement
As the intensity of jaundice is more in premature infants as compared to full-term infants, it is important to intervene and control the levels of bilirubin in the blood. Medical help is needed to prevent the onset of hyperbilirubinemia.
How Is Jaundice Diagnosed in Neonates?
While understanding the symptoms is vital in seeking early treatment and preventing health complications, it is equally important to understand jaundice’s diagnostic criteria. Children born at full term leave the hospital within 72 hours of their birth at most. They are called back in for necessary body checkups which help diagnose any health problems that may persist. For premature infants, the situation is complex. These children may be suffering from underlying conditions which make it difficult to diagnose issues in the traditional sense.
There are two types of jaundice for pre-term infants; pathological and physiological jaundice. In the case of physiological, the infant develops jaundice on the third day of their birth and recovers after 15 days. It may extend to one month. For pathological jaundice, the situation develops fast within 24 hours alongside the symptoms described above. Pathological jaundice should be promptly treated to prevent further complications.
Premature infants may suffer from a syndrome called non-hemolytic jaundice. In this condition, the jaundice is present from a young stage and is shown to be increasing. This is common for neonates as they are born with various medical complications like infections, asphyxia, hypoxia, etc. The levels of bilirubin have not reached the point to diagnose them as suffering from pathological jaundice. However, there can be a chance of the infant having bilirubin encephalopathy which is an uncommon form of the neurological disorder where jaundice reaches the brain tissue.
This shows just how difficult it is to diagnose premature infants as their serum levels fluctuate due to several underlying conditions. To be on the safe side, it is recommended to take high levels of bilirubin seriously and treat the infants for jaundice.
For pre-term infants, the levels of bilirubin should be lower than even the standard amount. This is because the red blood cell count is higher in premature infants as compared to full-term infants. In normal cases, the red blood cells in excess are broken down by the liver and the bilirubin is expelled out of the body through natural excretion. In the case of premature infants, the liver is underdeveloped and is not functioning at its optimal rate. It is not able to properly expel the substance from the bloodstream. As a result, it can easily get absorbed into the brain. This can cause bilirubin encephalopathy and put the infant at high risk.
What Is the Treatment of Jaundice in Neonates?
There are several treatments used to treat pre-term infants suffering from jaundice. They are described below:
Blue Light Therapy
This is the most common form of treatment against the illness. The infant is placed under a special type of blue light called bili light. This method is the safest and has the least amount of side effects. This helps decrease the levels of bilirubin in the blood as the light breaks down the bilirubin by using photo-oxidation. This process binds oxygen to bilirubin, and this allows the liver to break down bilirubin with ease. The infant is exposed to the light for the whole day with only breaks for feeds until a safe level is reached.
Full Blood Transfusion
If the level of bilirubin in the premature infant does not fall from dangerous levels then a blood transfusion may be needed. This process involves removing all the blood from the baby and the body will be transfused with bilirubin-free blood. The blood transfused will be taken from a matched donor and will help lower the bilirubin levels dramatically. The infant is kept under strict observation to treat any complications. The therapy may be done again if the levels do not decrease.
Several medications can be administered depending on the severity of the illness. Doctors can prescribe medicines that will produce enzymes – these are known as enzyme inducers. Injection of fresh plasma or glucose into the system can be done as well. Sometimes the baby develops rhesus disease when the antibodies in the blood attack the red blood cells. In this case, a very high dosage of intravenous immunoglobulin is injected. This prevents the baby from becoming anemic or developing an intense form of jaundice.
Other Common Forms of Therapy
There are other forms of non-medication treatments that can be administered. These include keeping the infant warm, starting feed that can build immunity and health, giving oxygen etc. For pre-mature infants residing in the neonatal units, these treatments are given from the start to prevent them from getting worse. Their vitals are continually monitored and slight changes are noted for future reference.
Jaundice is something that should not be a cause of worry. It is very natural for a child to develop it several days post-birth. In most cases, babies make the recovery completely on their own, and no serious medical assistance is required.
When it comes to premature babies, it is important to keep a note of all the little changes happening inside their bodies. Very often even the slightest changes in the levels can incite a severely damaging health problem. If your child is born pre-term and is developing jaundice, there is no need to panic. Your child will be properly cared for by trained professionals. As seen above, consistent treatment will allow your child to make a full recovery soon.