Jaundice

Subject: Midwifery III (Theory)

Overview

Newborn babies with jaundice often have yellowish skin and eyes. An infant with jaundice has an abnormally high concentration of bilirubin, a yellow pigment found in red blood cells. Infant jaundice is frequent, especially in newborns born before 38 weeks of gestation (preterm babies) and in certain breastfed infants. If a baby's liver isn't developed enough, it can't filter out the bilirubin that's already in the blood, leading to the yellowing of the skin and eyes. Jaundice is often a symptom of a more serious condition. Infant jaundice, characterized by the yellowing of the skin and the whites of the eyes, typically manifests itself between the second and fourth day after delivery. The most common reason for jaundice is hyperbilirubinemia or an overabundance of bilirubin in the blood. The jaundice-causing bilirubin is a natural byproduct of hemolysis and contributes to the production of a yellow pigment. Jaundice might be a symptom of a deeper medical problem. The onset of jaundice in these conditions might be either significantly early or later than in cases of true jaundice. When left untreated, mild jaundice in infants usually clears up on its own within two to three weeks. Your baby's time in the newborn nursery may be extended or he or she may require readmission to the hospital if jaundice is moderate to severe. Therapeutic use of light (phototherapy). Babies may be exposed to blue-green light from special lamps. The light alters the molecular structure of bilirubin so that it may be passed out of the body in the urine and feces. The only clothing your infant will need throughout therapy is a diaper and eye protection. There is the option of using a mattress or pad that emits light to enhance the therapeutic effects of the light treatment.

Newborn babies with jaundice often have yellowish skin and eyes. To put it simply, jaundice in infants is caused by an overabundance of bilirubin, a yellow pigment of red blood cells.

Babies born before 38 weeks of gestation (preterm babies) and certain breastfed infants are more likely to develop jaundice than other infants. If a baby's liver isn't developed enough, it can't filter out the bilirubin that's already in the blood, leading to the yellowing of the skin and eyes. Jaundice is often a symptom of a more serious condition.

Symptoms:

  • Infant jaundice, characterized by the yellowing of the skin and the whites of the eyes, typically manifests itself between the second and fourth day after delivery.
  • pallor bilirubin is more than 15 mg/dl 
  • generalized edema.
  • if it's related to an ABO or Rh incompatibility, the Coombs test will come back positive.
  • The duration of jaundice may be longer than two weeks.


Causes:

The most common reason for jaundice is hyperbilirubinemia or an overabundance of bilirubin in the blood. The jaundice-causing bilirubin is a natural byproduct of hemolysis and contributes to the production of a yellow pigment.

Various Other Factors:

Jaundice might be a symptom of a deeper medical problem. In these situations, jaundice often shows up much earlier or much later than PHYSIOLOGIC JAUNDICE.    Jaundice can be caused by a variety of diseases and health issues, including but not limited to:

  • iNTERNAL BLEEDING (hemorrhage)
  • The infant has a blood infection (sepsis)
  • Other infections caused by viruses or bacteria
  • Caused by maternal blood incompatibility or fetal liver disease
  • A condition in which your infant's red blood cells are abnormal and easily rupture.

Risk factors: 

Factors that increase the likelihood of developing jaundice, especially severe jaundice that might lead to problems, include:

  • Birth before its time. When compared to full-term infants, premature infants may have slower bilirubin clearance. As a result, he or she may eat less and have fewer bowel movements, both of which contribute to lower bilirubin elimination.
  • severe birth trauma including bruising. A greater amount of bilirubin, caused by the breakdown of more red blood cells, may be present in your infant if he or she is bruised during delivery. The matter of blood type. A newborn whose blood type is different from that of his or her mother may have gotten antibodies from the mother through the placenta that accelerate the breakdown of his or her blood cells.
  • Breast-feeding. Babies who are breastfed are more likely to develop jaundice, especially those who have trouble nursing or who do not obtain enough nourishment from their mothers' milk. The development of jaundice may be facilitated by dehydration or an inadequate diet.


Tests and diagnosis:

  • Diagnostic procedures for jaundice include:
  • Examination of the patient's physical condition
  • Evaluation of your infant's blood at a lab
  • A transcutaneous bilirubinometer is a device used for a skin test in which the reflection of a certain light is measured.


Treatments and drugs:

When left untreated, mild jaundice in infants usually clears up on its own within two to three weeks. Your baby's time in the newborn nursery may be extended or he or she may require readmission to the hospital if jaundice is moderate to severe.

Your baby's blood bilirubin level may be lowered by the following treatments:

Light therapy (phototherapy):

Putting the infant in a room with blue-green light is one option. The light alters the molecular structure of bilirubin so that it may be passed out of the body in the urine and feces. The only clothing your infant will need throughout therapy is a diaper and eye protection. There is the option of using a mattress or pad that emits light to enhance the therapeutic effects of the light treatment.

Intravenous immunoglobulin (IVIg):

Birth defects and jaundice have been linked to maternal blood type abnormalities. Babies born with this illness inherit antibodies from their mothers that tear down their blood cells.

Exchange transfusion:

Exchange transfusions of blood are reserved for extreme cases of jaundice in infants where other therapies have failed.

Complications:

Severe jaundice caused by high bilirubin levels can lead to life-threatening consequences if left untreated.

Acute bilirubin encephalopathy

The brain cells are very sensitive to bilirubin. Acute bilirubin encephalopathy occurs when bilirubin leaks into the brain, which can happen if an infant has severe jaundice. apathy, or having trouble getting out of bed Screeching at a very high pitch Feeding or sucking difficulties Constantly hunching one's back and neck 

  • Fever
  • Vomiting
  • Kernicterus
  • If acute bilirubin encephalopathy develops irreversible brain damage, the resulting condition is called kernicterus. Causes of kernicterus include:
  • Involuntary and uncontrolled movements (athetoid cerebral palsy)
  • Permanent upward gaze
  • Hearing loss
  • Failure of dental enamel to form properly
Things to remember
  • Newborn babies with jaundice often have yellowish skin and eyes. An infant with jaundice has an abnormally high concentration of bilirubin, a yellow pigment found in red blood cells.
  • Infant jaundice is frequent, especially in newborns born before 38 weeks of gestation (preterm babies) and in certain breastfed infants.
  • If a baby's liver isn't developed enough, it can't filter out the bilirubin that's already in the blood, leading to the yellowing of the skin and eyes.
  • Jaundice is often a symptom of a more serious condition.
  • Infant jaundice, characterized by the yellowing of the skin and the whites of the eyes, typically manifests itself between the second and fourth day after delivery.
  • The most common reason for jaundice is hyperbilirubinemia or an overabundance of bilirubin in the blood.
  • The jaundice-causing bilirubin is a natural byproduct of hemolysis and contributes to the production of a yellow pigment.
  • Jaundice might be a symptom of a deeper medical problem. The onset of jaundice in these conditions might be either significantly early or later than in cases of true jaundice.
  • When left untreated, mild jaundice in infants usually clears up on its own within two to three weeks.
  • Your baby's time in the newborn nursery may be extended or he or she may require readmission to the hospital if jaundice is moderate to severe.
  • Therapeutic use of light (phototherapy). Babies may be exposed to blue-green light from special lamps.
  • The light alters the molecular structure of bilirubin so that it may be passed out of the body in the urine and feces.
  • The only clothing your infant will need throughout therapy is a diaper and eye protection.
  • There is the option of using a mattress or pad that emits light to enhance the therapeutic effects of the light treatment.
Questions and Answers

Infant jaundice is a yellow discoloration of the skin and eyes of a newborn child. Jaundice in infants is caused by an accumulation of bilirubin, a red blood cell pigment that is yellow in color.

Yellowing of the skin and the whites of the eyes is a sign of infant jaundice that usually appears between the second and fourth day after birth.

  • Pallor bilirubin is more than 15 mg / dl.
  • Generalized edema.
  • There is positive coombs test if it is associated with ABO or Rh incompatibility.
  • Jaundice may persist for more than 14 days.

 

Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of red blood cells.

Other Causes

An underlying disorder may cause jaundice. In these cases, jaundice often appears much earlier or much later than physiologic jaundice. Diseases or conditions that can cause jaundice include:

  • Bleeding inside the body (hemorrhage).
  • A blood infection in your infant (sepsis).
  • Additional bacterial or viral illnesses.
  • An incompatibility between the mother's and child's blood types.
  • A problem with the liver.
  • A condition that causes your baby's red blood cells to break.

Treatments to lower the level of bilirubin in your baby's blood may include:

  • Light Therapy (phototherapy): Baby may be placed under special lighting that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in the urine and stool. During treatment, your baby will wear only a diaper and protective eye patches. The light therapy may be supplemented with the use of a light-emitting pad or mattress.
  • Intravenous Immunoglobulin (IVIg): Jaundice may be related to blood type differences between mother and baby. This condition results in the baby carrying antibodies from the mother that contribute to the breakdown of blood cells in the baby.
  • Exchange Transfusion: Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood.

Complications

  • High levels of bilirubin that cause severe jaundice can result in serious complications if not treated.
  • Acute bilirubin encephalopathy.
  • Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there's a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy.
  • Listlessness or difficulty waking.
  • High-pitched crying.
  • Poor sucking or feeding.
  • Backward arching of the neck and body.
  • Fever.
  • Vomiting.

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