The concept of understanding neonatal jaundice

Sign and symptoms of neonatal jaundice

Cause of neonatal jaundice
Treatment of neonatal jaundice

Neonatal jaundice is a yellowish discoloration of the skin, conjunctiva, and mucosa due
to accumulation of bilirubine.
Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a
newborn baby due to high bilirubin levels. Other symptoms may include excess
sleepiness or poor feeding. Complications may include seizures, cerebral palsy, or
jaundice.

Neonatal jaundice is jaundice in newborns, it can be a physiological symptom or it can

be a pathological thing.
Bronze baby syndrome (dark pigmentation of skin).The primary symptom is a yellow
color change of the white part of the eyes and skin of a newborn baby. Other symptoms
may include excess sleepiness or poor feeding. In most of cases there is no specific
underlying disorder (physiologic). In other cases it results from red blood cell
breakdown, liver disease, infection, hypothyroidism, or metabolic disorders (pathologic).
A bilirubine level more than 34 μmol/l (2 mg/dL) may be visible. Concerns, in otherwise
healthy babies, occur when levels are greater than 308 μmol/L (18 mg/DL), jaundice is
noticed on the first day of life, there is a rapid rise in levels, jaundice lasts more than two
weeks, or the baby appears unwell. In cases where the findings are of concern, it is
recommended that additional investigations be conducted to identify the underlying
cause.

In newborns, jaundice tends to develop because of two factors—the breakdown of fetal

hemoglobin as it is replaced with adult hemoglobin and the relatively immature
metabolic pathways of the liver, which are unable to conjugate and so excrete bilirubine
as quickly as an adult. This causes a buildup of bilirubin in the bloodstream
(hyperbilirubinemia), leading to the symptoms of jaundice.
If the neonatal jaundice is not resolved with simple phototherapy, other causes such as
biliary atresia, Progressive familial intrahepatic cholestasis, bile duct paucity, Alagille
syndrome, alpha 1-antitrypsin deficiency, and other pediatric liver diseases should be
considered. The evaluation for these will include blood work and a variety of diagnostic
tests. Prolonged neonatal jaundice is serious and should be followed up promptly.

The need to treat depends on the level of bilirubine the age of the child and the
underlying cause. Treatments may include more frequent feeding, phototherapy, or
exchange transfusions. In those who are born early more aggressive treatment tends to
be required. Physiologic jaundice generally lasts less than seven days. The condition
affects over half of babies in the first week of life. Of babies that are born early about
80% are affected. Globally, over 100,000 premature or term babies die of jaundice
every year.
Bilirubine levels for the phototherapy initiative vary with the age and condition of the
newborn. However, all neonates with total serum bilirubin greater than 359 μmol/l (21
mg/DL) should receive phototherapy.
a. Phototherapy
 Babies with neonatal jaundice may be treated with colored light
called phototherapy, which works by changing trans-bilirubine into the water-
soluble cis-bilirubine isomer
This phototherapy is not an ultraviolet light therapy, but a precise frequency of
blue light. The light can be applied with overhead lamps, which means that the
baby's eyes need to be covered, or with a device called a blanket which sits
under the baby's clothing close to its skin.
b. Exchange transfusions
Much like with phototherapy the level at which exchange transfusion should
occur depends on the health status and age of the newborn. It should however
be used for any newborn with a total serum bilirubin of greater than 428 μmol/l
(25 mg/DL)

References
Blackburn, S.T. (2007). Maternal, Fetal And Neonatal Physiology: A Clinical
Perspective. Edisi ke-3. ST. Louis: Saunders

McDonagh, A. F. (2007). "Movement of Bilirubin and Bilirubin Conjugates Across the

Placenta". Pediatrics

Leung, A. K.; Sauve, R. S. (1989-12-01). "Breastfeeding and breast milk

jaundice". Journal of the Royal Society of Health

Ladewig, P.W. (2013). Buku Saku Asuhan Ibu dan Bayi Baru Lahir. Jakarta: EGC

Bhutani V.K., 2001. Neonatal hyperbilirubinemia and risk of subtle neurologic

dysfunction. Pediatric Research.

MacDonald M.G, Boardman J, Ramasethu J, 2021. Avery MacDonald's Neonatology:

Pathophysiology and Management of the Newborn.

Mansjoer,A. 2000. Kapita Selekta Kedokteran Jilid I. Jakarta: Media Aesculapius

Saifuddin, A. 2014. Buku Panduan Praktis Pelayanan Kesehatan Maternal dan

Neonatal. Jakarta: Yayasan Bina Pustaka Sarwono Prawiharohardjo.