Jaundice is a condition where a person’s skin, eyes and mouth take on a yellow tinge. This condition occurs due to the deposition of excess bilirubin. Neonatal Jaundice is a condition that commonly occurs during the first few days of a baby’s life.
It is part of a normal turnover cycle for red blood cells to break down and when they do, bilirubin is produced. During a process called conjugation, bilirubin goes to the liver and intestines, before it is eventually excreted out of the body through the kidneys. Neonatal Jaundice occurs when the total serum bilirubin level goes beyond 5mg/dl or 86 umol/L – a level considered high.
| This is because red blood cells have a shorter life span in babies as compared to adults. This higher turn-over of red blood cells leads to higher production of bilirubin. Furthermore, if the baby sustains any bruising during the birth process (eg during vacuum or forcep delivery methods), more red blood cells will be broken down and hence leading to a higher level of bilirubin. |
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Many newborns develop jaundice also because a baby’s immature liver is too young to handle high levels of bilirubin. The excess amount is therefore deposited under the skin and eyes, leading to jaundice. The condition usually peaks during the 4th to 6th day of a baby’s life, at about 6mg/dL or 100 umol/L. Bilirubin level then declines over the next one to two weeks to normal adult level. Occasionally, the bilirubin level can be so high that treatment by phototherapy is required.
During the initial staqe, the baby develops tiredness, poor feeding and has a high-pitch cry. At the later stage, the baby becomes easily irritable and may suffer from fits, breathing difficulties and fever. Chronic conditions that may result from high level of jaundice are cerebral palsy, hearing loss and even mental retardation.
Jaundice in newborns can also be associated with serious illnesses such as haemolytic disease, metabolic and endocrine disorders, structural abnormalities of the liver and infections.
• The doctor will check the baby for jaundice, his general well-being and look out for any signs of illnesses
• If jaundice is detected, a small amount of the baby’s blood will be taken to measure the level of bilirubin
• The doctor will order further tests or refer baby for phototherapy treatment, if necessary
For babies on breastmilk, it’ll be good to increase the frequency of feeding. It is because neonatal jaundice may be exacerbated by calorie deprivation. Mothers can also supplement her milk with formula milk. In the event that a short-term interruption of breast-feeding is necessary due to very high level of jaundice, as instructed by the doctor, mothers must remember to continue expressing their milk.
Phototherapy is required for babies who have more than 200 to 300umol/L of bilirubin, depending on their age and presence of risk factors. Phototherapy utilizes the blue wavelength of light to convert bilirubin to less toxic substances. This service is available by referral in hospitals (such as KKH Women’s and Children’s Hospital and National University of Hospital). When babies are put on phototherapy, it is important to monitor for rash, burn, temperature fluctuation and dehydration.
Some would have heard of exposing the baby to sunlight as a method. However, this method has not been found to be useful clinically in treating jaundice. Moreover a prolonged exposure to bright sunlight – anytime from 10am to 3pm – may lead to sunburn for the baby, with potentially serious consequences.
Jaundice is a very common condition in babies. A routine check is advised in the first week of the baby’s life. For most babies, only close monitoring or an adjustment of feeding pattern is required.
By: Dr Derek Tse, Deputy Director, SingHealth Polyclinics - Sengkang