Hyperbilirubinemia - Newborn Jaundice

Overview, Causes, & Risk Factors

Jaundice is a yellowish discoloration of the skin and the whites of the eyes. It is caused by too much of a chemical called bilirubin in the blood.

What is going on in the body?

The hemoglobin molecule in a red blood cell carries oxygen to all the cells in the body. Each hemoglobin molecule contains four molecules of iron. The body usually separates and recycles iron from hemoglobin molecules. Bilirubin is a normal chemical by-product of this recycling process. The body does not need bilirubin. Bilirubin travels through the blood to the liver. The liver converts it so that it can be removed in urine. When a child or adult has too much bilirubin in their blood, they become jaundiced.

It takes a few days for a newborn's liver to start processing bilirubin. It may take longer in infants who are born prematurely or who are breast-fed. About 80% of premature infants and 60% of full-term infants will have some visible jaundice. This is a normal condition. It is not harmful and will usually go away without treatment.

There are two main causes for too much unprocessed bilirubin. One cause is that more bilirubin is being made than can be processed. The other cause is that the baby cannot get rid of the processed bilirubin.

What are the causes and risks of the condition?

A baby born prematurely is more at risk for jaundice. Infection, not getting enough oxygen during birth, and some medicines may increase the baby's risk of jaundice.

Some common causes of jaundice due to elevated levels of bilirubin include:

a baby's blood type that is different from the mother's. For example, the mother has blood type O+, and baby is B+.

a collection of blood between the scalp and the skull from pressure on the head during the birthing process. If there is a lot of blood, too much bilirubin can result.

an identical twin who gets more blood than the other twin in the uterus. The baby who gets more blood can develop jaundice after it is born.

inherited defects of the red blood cell

Jaundice from the baby's inability to remove bilirubin can be caused by the following conditions:

babies with certain blood infections

a blockage or cyst on the baby's bile duct

breast-feeding

genetic disorders, such as Down syndrome

medicines, such as antibiotics

thyroid abnormalities

Symptoms & Signs

What are the signs and symptoms of the condition?

In the newborn, jaundice first becomes visible on the face. As levels of bilirubin go up, the jaundice will move from head to toe. By the time an infant is jaundiced all over, bilirubin levels should be measured. Just looking at the baby is not an accurate test. Color can be influenced by many things, such as lighting or the color of the walls.

Infants with higher levels of jaundice look more orange than yellow. The jaundice is more intense. Babies with higher bilirubin levels often are motionless and do not feed well.

Diagnosis & Tests

How is the condition diagnosed?

Blood tests are done to find out how much bilirubin is present and why. The parents are asked if there might be any inherited causes. The health of the mother and baby during the pregnancy may give answers. The baby is examined for infection, anemia, liver disease, and other problems. An ultrasound examination of the liver and bile duct system might be needed. A sample of cells from the infant's liver may be required for a biopsy.

Prevention & Expectations

What can be done to prevent the condition?

Some cases of newborn jaundice can be avoided by providing good prenatal care to the mother. Blood tests are available that measure bilirubin levels. The amniotic fluid can be checked. If there are problems, the fetus might need a blood transfusion. There are also medicines the mother can take to help prevent the condition.

What are the long-term effects of the condition?

Infants who suffer brain damage from high levels of bilirubin may develop severe symptoms. These include a high-pitched cry, body stiffness, and seizures. Some of these infants die. Those who survive will develop symptoms as they age. By age 3, they may develop a type of cerebral palsy, seizures, communication

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Some infants may be only mildly affected. They may lack muscular coordination and may develop partial deafness and attention deficit disorders.

Infants who develop an obstruction in the bile ducts will need surgery. The surgery does not always work. If not, a liver transplant may be the only hope for long-term survival.

What are the risks to others?

Newborn jaundice is not contagious and poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

Too much unprocessed bilirubin can cause complications. The unprocessed bilirubin can get into the brain where it causes permanent damage. It usually takes a fairly high level of unprocessed bilirubin to be toxic. High levels of processed bilirubin are not as toxic. However, high levels of processed bilirubin suggest the need for prompt attention.

Most infants with newborn jaundice can be treated with special lights used for phototherapy. Unprocessed bilirubin in the skin can be processed if it is exposed to fluorescent light. Focused halogen lights and fiber-optic, wrap-around blankets have also been used. With training and supervision, the infant's parents can use these treatments at home.

Some types of jaundice cannot be treated with phototherapy. An exchange transfusion may be needed. A catheter is inserted into the belly button, or umbilicus. A small amount of the baby's blood is removed. It is immediately replaced with donor blood. This is repeated until enough blood has been exchanged. Then the bilirubin level is measured at intervals. This procedure has risks. It should be done only by trained staff with proper equipment.

Breast milk jaundice is harmless. It will quickly go away and not come back if the mother stops breast-feeding for 24 to 48 hours. Formula is used during this time to keep the newborn nourished.

What are the side effects of the treatments?

Phototherapy can be harmful to the eyes, so the baby's eyes must be protected. Exchange transfusion can cause changes to the acid levels in body fluids, called metabolic acidosis. It can also cause low blood glucose or calcium levels, changes in heart rate, and inadequate breathing. The baby may need resuscitation. Clotting or infection of the umbilical vein could result in liver complications.

Surgery is associated with a risk of infection or bleeding after the operation.

What happens after treatment for the condition?

Most cases of newborn jaundice resolve without any further problems. Underlying problems, such as liver disease, may require further treatment.

How is the condition monitored?

Infants who have transfusions must be watched carefully. They can develop anemia, which is a low red blood cell count, or bile stoppage. Inherited diseases causing jaundice and conditions requiring surgery need long-term follow-up care. Any new or worsening symptoms should be reported to the healthcare provider.