For Gayatri Baishya, the arrival of her newborn in August 2021, was coupled with the stress of seeing the baby in the neonatal ICU. The baby girl was diagnosed with neonatal jaundice. Her bilirubin levels peaked on the second day of her birth.
Baishya, herself being a nurse, was quick to understand the baby’s condition. “I suspected jaundice when I noticed the white part of her eye turning yellow. After confirmation through a blood test, the doctors put her on phototherapy treatment for 24 hours and she recovered easily. The doctor asked me to breastfeed her well and make sure she’s exposed to sunlight regularly,” she says.
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If a newborn, medically called a neonate, looks pale with a yellowish appearance, chances are that the baby has neonatal jaundice or hyperbilirubinemia. It is a condition in which there is too much bilirubin in a newborn baby’s blood. Bilirubin is the yellow pigment in bile juice that is released by the liver.
Neonatal jaundice, a treatable, but temporary condition in babies could sometimes be an indication of an underlying issue.
Jaundice in a newborn: Blame the immature liver enzymes
According to Dr Bhaskar Shenoy, a Bengaluru-based pediatrician, one of the major causes of neonatal jaundice is the immaturity of the liver enzymes which metabolises bilirubin.
“The red blood cells get destroyed to form bilirubin. The red blood cells go through the liver, where there are many enzymes to break down bilirubin. In newborns, these enzymes are not well developed, which is why bilirubin is not metabolised properly leading to what we call physiological jaundice,” says Dr Shenoy.
The two types of jaundice in a newborn
Dr Shenoy points out that there are two types of neonatal jaundices – physiological and pathological.
Physiological jaundice usually starts on the second day of childbirth.
Pathological jaundice occurs on the first day of birth, in which case, the jaundice is indicative of an underlying disease. It is more severe and requires immediate medical attention.
Dr Manisha Bavadeker, a pediatrician in Sanjeevani Medical Centre, Mumbai, on a call with Happiest Health, says the two common reasons for physiological jaundice are high hemoglobin levels and immaturity of the liver function.
Dr Shenoy mentions other causes that can lead to jaundice:
- Not having an adequate feed
- Incompatibility of blood groups of the mother and the baby: ABO incompatibility (the mother’s blood group is O+ and the baby is either A+ or B+) and Rh factor incompatibility (Rh or Rhesus is an inherited factor on the surface of the red blood cells; if it is present, it is called Rh+ and its absence is termed as Rh-)
- Thyroid hormone deficiency
- G6PD deficiency (a genetic condition due to lack of the enzyme G6PD that breaks down red blood cells)
- TORCH infection (a group of infections such as toxoplasmosis, rubella, cytomegalovirus, herpes simplex and HIV) during pregnancy can affect the developing fetus. If the mother develops an infection after delivery, she could pass it on to the infant through breastmilk
When the newborn is positive for jaundice
Dr Bavadeker says that first-day jaundice is always pathological. “It is usually because of ABO & Rh incompatibility,” she adds.
“Physiological jaundice usually starts at day three and rises for four or five days. It will touch the baseline after a week or ten days. In such cases, what matters is the level of bilirubin in the baby. Jaundice on day one is very risky; the doctors must act fast. Pathological jaundice caused by Rh incompatibility is more severe than ABO incompatibility,” explains Dr Shenoy.
Screening and symptoms
Dr Shenoy says, “A term baby born in nine months with a normal birth weight will have typical symptoms like yellowing of the sclera (the white part of the eye) and the skin, due to deposition of bilirubin. A routine check-up is always done, and the next step is to estimate the baby’s bilirubin levels through a serum bilirubin blood test.”
Dr Bavadeker reaffirms, “The baby is monitored daily while still at the hospital for any signs of jaundice. Even after being discharged, they are called in for a follow-up. Besides colouration of the eyes, dark yellow-coloured urine can also indicate jaundice.”
Why preterm babies are more at risk
“Jaundice is more common and higher among preterm babies because of their low birth weight, especially those that are ABO incompatible. Babies with G6PD deficiency and spherocytosis (a hereditary condition where red blood cells are sphere-shaped rather than disk-shaped) are also more at risk,” says Dr Bavadeker.
Dr Shenoy adds that a preterm baby is more likely to bear the ill effects of bilirubin accumulation. “The reason for concern is the neurological impairments that can occur due to bilirubin in blood crossing the blood-brain barrier which depends on the weight of the child and the gestational age (the period between conception and birth). These impairments are likely to be more in a preterm baby.”
Dr Shenoy further explains that for a term baby, 20 mg of bilirubin won’t cause bilirubin to cross the blood-brain barrier; whereas for a preterm baby, even 10-12 mg is enough for the same to happen.
Phototherapy as treatment
Dr Bavadeker explains how phototherapy works. “Phototherapy converts the bilirubin into some other component which can be easily degraded by the liver and excreted from the urine. Babies are kept in an open incubator where they are exposed to a specific wavelength of light that breaks down bilirubin,” she says.
“All babies who have jaundice may not need phototherapy. The levels of bilirubin, gestational age, and underlying comorbidities determine the need for phototherapy. Suppose for a child born with a normal birth weight of around 2.5 kg and 14 milligrams of bilirubin, phototherapy is not given. It will resolve on its own. The only thing is we keep a close watch on whether it increases or not. Feeding well is also encouraged so that the excretion of bilirubin from the body occurs faster,” adds Dr Shenoy.
Jaundice in babies is of two types — physiological and pathological. Physiological jaundice starts on the second day of childbirth and pathological jaundice occurs on the first day of birth. Pathological jaundice is indicative of an underlying disease and requires immediate medical attention.