More than half of all newborns develop a milder or more pronounced yellowing of the skin shortly after birth, which in most cases is harmless. However, abnormal newborn jaundice must be treated.
What is neonatal jaundice?
In about 60 percent of all healthy newborns, a noticeable yellowing of the skin occurs in the first few days of life: neonatal jaundice. See percomputer for Skin Ringworm Explanation.
It is caused by accumulations of the yellow bile pigment bilirubin. In many cases, the symptoms are harmless and go away on their own. Then one speaks of a physiological neonatal jaundice, which does not require treatment.
However, if the symptoms persist for a certain period of time and the bilirubin levels in the blood exceed a certain mark, the disease must be treated. Premature birth increases the risk of newborn jaundice to 80 percent. In technical jargon, it is also referred to as a newborn jaundice.
Causes
In most cases, neonatal jaundice is due to normal metabolic processes after birth: In the womb, the fetus is supplied with oxygen by many red blood cells. It is a specific variety, abbreviated HbF.
After birth, the baby can breathe independently. So he needs fewer red blood cells and also a different kind, the HbA. The old blood cells must therefore be broken down, whereby the yellow bilirubin is formed. The liver of the newborn, which is not yet fully developed, cannot convert large amounts of bilirubin into an excretable form quickly enough, resulting in yellowing of the skin.
An increased breakdown of blood cells can occur, for example, if the blood groups of mother and child do not get along. Major bruising after birth and congenital anemia can also increase the incidence of neonatal jaundice. A premature birth, a system disorder of the bile ducts, certain metabolic disorders or some medications are other causes that can lead to insufficient breakdown of bilirubin.
Children suffering from the so-called Crigler-Naijar syndrome lack the enzyme responsible for breaking down bilirubin. Breastfeeding can also trigger a mostly physiological neonatal jaundice. The reasons for this are not yet clear.
Symptoms, Ailments & Signs
Neonatal jaundice typically occurs within the first few days of life. It first manifests itself through the yellowing of the skin and through the yellowish-white discoloration of the whites of the eyes. Most of the sick infants show a slightly sickly appearance and behave unusually. This can lead to increased activity or apathy, depending on the level of bilirubin levels and the individual course of the disease.
If the bilirubin levels do not exceed a certain value, the newborn jaundice subsides on its own. Further complications or late effects are not to be expected in this case. At higher values, on the other hand, bile pigments can be deposited in the brain. This can lead to physical and mental problems – it comes to the so-called kernicterus.
Sick infants are constantly tired and often yawn. Appetite and drinking habits are reduced, resulting in deficiency symptoms and dehydration relatively quickly. In the further course, the muscle tension increases and the typical hollow back with a straight back is formed.
Accompanying this, the child becomes more and more restless, screams and cries or shows itself to be apathetic in the meantime. Shortness of breath and seizures also occur at this stage of the disease. In the long term, severe neonatal jaundice can cause hearing and vision problems , developmental disabilities, and birth defects.
Diagnosis & History
Physiological neonatal jaundice develops between the third and sixth day after birth and recedes by the tenth or fourteenth day.
The yellowing of the skin and the whites of the eyes is clearly visible. The doctor may check the levels of bilirubin in the blood. The doctor receives initial information with the help of a multispectral device. This allows him to measure the proportion of colored light that can penetrate the skin. If there are indications of increased values, blood tests are carried out that provide information on the causes. Furthermore, the bile and liver are checked, for example with ultrasound images.
Abnormal neonatal jaundice can cause the child to become sleepy and drink little. The reason for this is that the bilirubin can be deposited in certain areas of the brain. In the course of this so-called kernicterus, increased muscle tension with a hollow back, shortness of breath, high-pitched screams and seizures can occur. Long-term effects can include visual and hearing disorders, reduced mental development and movement disorders.
Complications
Neonatal jaundice, or neonatal jaundice, occurs in 60 percent of newborns and is usually harmless. The disease is caused by the necessary remodeling or replacement of the red blood cells after birth. The massive breakdown of erythrocytes of the HbF type causes a temporary flooding of the metabolism with the breakdown product bilirubin, which causes the typical yellow skin discoloration.
Normally there are no further complications, even if left untreated, and the yellow discoloration disappears completely after 10 to 14 days. However, if there is pathological jaundice in the newborn, if left untreated, serious symptoms can develop, which can also cause irreversible damage. If the concentration of bilirubin in the blood is too high due to the insufficient ability to break it down, the substance can settle in the brain. A so-called kernicterus then sets in, which leads to increased muscle tone.
Affected newborns are usually sleepy and drink poorly. They tend to have a pronounced hollow back, shrill screams and also seizures and shortness of breath. If left untreated, irreversible long-term damage such as visual and hearing disorders, movement anomalies and reduced mental development can also set in. A target-oriented therapy offers an irradiation of the skin with blue light. This facilitates the conversion of bilirubin to its water-soluble form, which greatly facilitates its breakdown and elimination.
When should you go to the doctor?
In the case of an in-patient birth or a delivery accompanied by an obstetrician, the nurses, midwives or doctors present will carry out the initial examinations of the newborn. If they discover irregularities or peculiarities in the general state of health of the infant, further steps are taken independently to ensure adequate medical care. Parents or relatives do not have to take action in these cases.
However, if the first signs of a health impairment only appear a few days after the birth, there is a need for action on the part of the parents. If there is a change in the complexion, yellowing of the skin or behavioral problems in the offspring, a doctor should be consulted to clarify the symptoms. If the newborn refuses to eat, is very restless or cries incessantly, there is a health problem that needs to be diagnosed and possibly treated. Although newborn jaundice does not necessarily require medical attention, it is always advisable to see a doctor.
In particular, other diseases should be ruled out by medical examinations so as not to endanger the life of the newborn. Muscle tension, listlessness or apathy are other indications that should be followed up. If the infant shows an excessive need for sleep or a respiratory disorder, a doctor should be informed of the observations. In the event of shortness of breath, a doctor must be consulted immediately.
Treatment & Therapy
Malignant neonatal jaundice is often treated with light or phototherapy. For this purpose, the skin is irradiated with blue light, which stimulates the bilirubin to convert into its water-soluble form.
This allows the body to break down the dye more easily. A harmless skin rash, which usually does not itch, can develop as a side effect of light therapy. If the bilirubin concentration in the blood is greatly increased, a blood exchange by means of an exchange transfusion is necessary.
Treatment is started fairly quickly in premature babies and in infants who develop jaundice particularly early. If the neonatal jaundice lasts longer, it is probably a problem with the bile ducts. Light therapy can help here.
Prevention
There are very few ways to prevent newborn jaundice. As far as possible, the baby should not be taken out of the womb before the expected date. Many parents also try to give their child as much light and sun as possible.
However, the blazing midday sun is not suitable. The sun is most pleasant for sensitive baby skin in the early morning and late afternoon. Sun protection products should not be missing. Homeopathic medicines such as Phosphorus C30 can also be useful.
Aftercare
Because most cases of neonatal jaundice do not require treatment, specific follow-up care is usually not required. It usually heals within a short time without treatment. After two to three weeks at the latest, the child’s yellowish skin color should have disappeared by itself. If this is not yet the case, additional measures may be necessary on the advice of the doctor.
Usually, however, no special follow-up examinations are necessary because of jaundice. The attending pediatrician will observe the disease as part of the usual check-ups for newborns. In addition, the midwife will continue to check whether the jaundice has completely healed or whether there is a need for action. If the symptoms persist for a longer period of time, the pediatrician usually orders a current blood test for the child.
The bilirubin level is checked again. Depending on the findings, further measures for aftercare or for renewed therapy may then be necessary. However, getting out with the affected child is the most important follow-up measure for neonatal jaundice. This is particularly necessary if the newborn has already been treated with phototherapy in the hospital.
You can do that yourself
If it can already be foreseen on the maternity ward that jaundice in the newborn is a dangerous form, treatment measures are taken in the hospital. However, there are some methods that parents can use at home to help the jaundice go away.
Parents should expose their child to sunlight as often as possible. The best way to do this is to lay the newborn naked in the light coming through the window. The rooms must be kept warm. Direct sunlight would be better, but there is a risk that the child will catch an infection. The window glass lets through the important “blue” light component anyway. At the same time, it helps to stimulate the newborn’s intestinal activity. Then the bilirubin that has already been excreted by the liver, which causes jaundice, is excreted directly and there is no risk of it getting back into the body.
The child should be breastfed as often as possible to stimulate milk production. Whether the intestinal activity is actually stimulated is noticeable in the child’s frequent bowel movements. However, you should refrain from feeding the baby with bottled food or even complementary food, as this only leads to irritation of the newborn body. There is also no need to give water or tea. Breast milk alone is enough.
