Neonatal Jaundice

Jaundice of the newborn
One of the more common problems we encounter in the newborn period is jaundice. This is simply when the baby presents with yellowing of the skin and or eyes as a result of increased bilirubin levels in the bloodstream.

We categorize these into 2 groups either:

• physiological (normal) jaundice of the newborn or
• pathological (diseased) jaundice of the newborn

In the majority of the cases, this jaundice is in the first category, normal jaundice of the newborn. This occurs because baby’s new liver is learning to cope with its new duties, one of them being the processing of bilirubin. This results in mildly elevated levels of bilirubin, and in turn yellowing of the skin. We now understand that this state of mildly elevated bilirubin levels actually is protective for the baby (an anti-oxidant) and is Mother Nature’s way of protecting baby from infection. No mom should ever stop breastfeeding or start giving baby water in between feeds. Exposure to sunlight is not necessary since this jaundice benefits the baby.

The above, however,  is what we call a diagnosis of exclusion, i.e. we can only diagnose the above by excluding pathological jaundice.
This is done by:

• clinical examination to exclude infection, such as a problem with baby’s liver or baby’s blood
• checking baby’s bilirubin level; this must be done by formal laboratory assessment. Simply “eyeballing” the baby and trying to determine how yellow baby is or to what extent the jaundice has spread is inaccurate. The level helps determine the degree of treatment required which can be anything from monitoring at home to intensive treatment in hospital to avoid a condition known as kernicterus. Kernicterus occurs when bilirubin levels are too high for baby’s weight and age, and settles on the brain leading to long term problems which could include anything from tics to cerebral palsy.

So in summary we need to look at several factors based on the baby’s age, weight, bilirubin level and other clinical parameters to determine if this is truly normal jaundice of the newborn, or diseased jaundice. The goal of which is to avoid any complications or long term effects in baby.

Article prepared by Dr NB Singh (Specialist Paediatrician)