Jaundice may pose serious threat to newborns: Expert

Jaundice may pose serious threat to newborns: Expert

By Donya Betancourt

SANUR, Bali (JP): Some newborns develop a condition called
"neonatal jaundice" or "hyperbilirubinemia", which happens to
about 25 percent to 60 percent of all newborns.

What is jaundice?

Jaundice is a condition when a person has yellow eyes and
yellow skin. The color results from "bilirubin" which is a yellow
pigment produced from red blood cells breaking down.

The physician diagnoses "jaundice" by measuring the
bilirubin level. Asians and Native American babies have elevated
levels that may be nearly double those of Caucasians and African
Americans.

Mild cases of neonatal jaundice usually resolve over the first
few weeks of life, but persistently high concentrations of
bilirubin can be dangerous.

Elevated levels of bilirubin interfere with a number of
cellular processes, and may be neurotoxic. Jaundice progresses
from head to toe, so an infant with mild facial jaundice is less
of a concern than an infant who has total body jaundice.

The skin should be checked against a white background over the
forehead and sternum, especially in darker skinned babies, to
accurately assess the degree of jaundice. Placing the baby on a
white sheet or blanket is also helpful, as opposed to using a
yellow colored background.

Why do red blood cells break down in a newborn?

There are two types of jaundice, "physiologic jaundice" and
"pathologic jaundice".

Physiologic jaundice occurs in most healthy full-term babies
in the first week of life and does not require special treatment.
It occurs from a lack of functions due to immature organs in
newborns. This is due to increased production (accelerated red
blood cell breakdown), decreased removal (transient liver enzyme
insufficiency) and increased reabsorption (enterohepatic
circulation).

Neonates have a higher volume of red blood cells and produce
the yellow pigment twice as much as adults and older children
because red blood cells in newborns have a shorter half-life than
an adults production capacity (90 days instead of 120 days in an
adult).

Nonphysiologic or pathologic jaundice occurs when there are a
number of pathologic conditions that can result in neonatal
jaundice. Examples include: Conditions that cause the destruction
of red cells, which can occur as a result of hemolysis, certain
enzyme deficiencies, or structural abnormalities in red cells.
The types of intestinal bacteria that metabolize bilirubin, and
in such cases, significant amounts of bilirubin is reabsorbed
into the blood.

Common causes

The most common cause is blood group incompatibility, I would
like to write about this topic more clearly in case you face this
problem.

Blood group incompatibility occurs when the mother and her
baby have differing blood types (ABO and/or Rh). When blood types
differ, the mother may produce antibodies to destroy the infant's
red blood cells. Blood incompatibility may even threaten the
fetus. The rapidly destroyed cells may overwhelm the body's
ability to get rid of the yellow pigment and consequently,
increase in levels.

Jaundice may be apparent during the first day of life. In the
past, Rh incompatibility was a relatively common cause of the
most severe form of jaundice. However, injecting the mother with
RhoGAM within 72 hours of delivery can prevent this condition.

RhoGAM prevents the formation of anti-Rh antibodies that can
endanger future Rh-positive pregnancies.

The relative positions of the mother and the baby immediately
following delivery should also be taken into account. If the baby
is below the level of the mother, gravity drainage of blood to
the baby may occur before the umbilical cord is cut. The baby
must destroy and excrete these excessive red blood cells from the
body. Increased red blood cell breakdown results in an increase
in yellow pigment production. This condition is called
"polycythemia".

The delivery process and extensive bruising of the baby is
associated with higher bilirubin levels as healing occurs. A lack
of bilirubin excretion, most often occurs when the bilirubin --
which has already been processed by the liver and sent to the
intestine for removal, is reabsorbed before it can be excreted in
the stool.

Jaundice related to breast-feeding is an example of under
excretion. Breast-milk jaundice occurs in babies that are nursing
well, gaining weight, have normal stools and look healthy. The
bilirubin level, instead of falling in the first week of life,
continues to rise. When the mother stops nursing for 48
hours, the bilirubin level will usually drop by 50 percent. When
nursing is resumed, the level will not be as high as before. The
cause is unclear but there is a 70 percent recurrence rate in
subsequent pregnancies.

However, if the body is unable to get rid of sufficient levels
of bilirubin, the level of bilirubin present in the body will
increase, resulting in hyperbilirubinemia.

An excessive level of bilirubin can lead to serious
neurological damage, which is called "kernicterus". Kernicterus
is a serious and life-threatening form of neonatal jaundice that
reflects the toxicity of bilirubin to the central nervous system.

Kernicterus -- in both acute and chronic forms -- manifests
itself by a variety of neurologic and cognitive defects, ranging
from poor suckling and seizures, to low IQ resulting in cerebral
palsy, hearing loss and mental retardation. Clearly, this
disorder should be treated without delay.

Unfortunately, the specific level of total serum bilirubin at
which lasting damage occurs has not been identified, although
levels of 12 mg/dL to 14 mg/dL are thought to be the upper limits
of "watchful waiting".

Signs

The following points are critical signs to tell you when you
should be concerned about jaundice: Jaundice present before 24
hours of age; Excessive weight loss and poor feeding; Infrequent
bowel movement; Dark urine or light colored stools; Prematurity;
Persistent jaundice beyond two weeks of age.

How is jaundice treated?

Most babies will clear excess bilirubin without treatment.
Observation and follow up can be successful in most of healthy
neonates. The babies who are unable to get rid of excessive
bilirubin will receive treatment as follows.

The most frequently used treatment is phototherapy. The blue
portion of the light spectrum causes a chemical reaction that
helps in the elimination of bilirubin via stool and urine. The
most frequently used form is phototherapy using a standard
fluorescent white light.

Another treatment is an exchange transfusion. In this
procedure, small amounts of blood (and hence bilirubin) are
removed from the baby and replaced with donor blood. This
procedure is performed if the risk of kernicterus is high.

Jaundice may be a normal part of a baby's adjustment to life
after birth, but extreme jaundice can have very serious
consequences. The American Academy of Pediatrics and the American
College of obstetricians and Gynecologists recommend that all
neonates discharged less than 48 hours of age be seen within
three days, either at home or in a health care center, by a
medical professional, experienced in assessing neonatal jaundice.

The writer is a pediatrician based in Sanur, Bali. Questions?
Contact her at drdonya@hotmail.com or features@thejakartapost.com