Neonatal Jaundice in Newborns: What Parents and Caregivers Need to Know
Verified by: Dr. Divya Cadabam
"You cradle your newborn in your arms, heart swelling with love — but then, you notice a yellowish tinge in their eyes or on their skin. Is it something normal or a cause for concern?"
Neonatal jaundice is a common condition in newborns, often causing yellowing of the skin and eyes. While usually harmless, it’s essential for parents and caregivers to understand its causes, symptoms, and when medical attention is necessary.
In this blog, we’ll uncover what neonatal jaundice really is, why it happens, how to spot it early, and when it’s time to call your doctor. Because when it comes to your newborn’s health, knowledge isn’t just power—it’s peace of mind.
What is Neonatal Jaundice?
Neonatal jaundice is a yellow discolouration of a newborn’s skin and eyes caused by high bilirubin levels. It’s common in newborns and usually resolves without treatment in healthy infants.
Overview of Neonatal Jaundice
Neonatal jaundice happens when a baby’s liver can't efficiently process bilirubin, a yellow pigment formed during red blood cell breakdown. Unlike adult jaundice, it’s typically due to liver immaturity and faster red blood cell turnover in newborns.
Why Newborns Develop Jaundice
Newborns have more red blood cells, which break down faster after birth. Their immature livers can't process bilirubin quickly enough, leading to buildup. This metabolic delay, combined with rapid bilirubin production, makes jaundice more common in infants than in adults.
Epidemiology of Neonatal Jaundice
Neonatal jaundice is a common condition, affecting up to 60% of term and 80% of preterm newborns worldwide within the first week of life. While most cases are mild, a smaller proportion require medical intervention.
Global Prevalence
Severe neonatal jaundice accounts for about 22% of all neonatal hospital admissions globally, with higher rates in developing regions. In developed countries, effective screening and treatment have lowered severe cases, but resource-limited settings still report higher morbidity and mortality.
Prevalence by Region and Population
Prevalence varies by race, ethnicity, and socioeconomic status. Infants of Southeast and East Asian descent, and those in sub-Saharan Africa and South Asia, show higher rates. Socioeconomic factors, such as limited healthcare access, further increase incidence and risk of complications.
Risk Factors for Neonatal Jaundice
Certain newborns face a higher risk of developing jaundice due to biological and genetic factors. Prematurity, blood type incompatibilities, and inherited conditions often increase the likelihood and severity of jaundice.
Premature Birth and Low Birth Weight
Premature infants have underdeveloped livers that can’t efficiently clear bilirubin, making jaundice more likely. Babies born before 37 weeks or with low birth weight often require extended hospital stays and treatments like phototherapy to manage bilirubin buildup effectively.
Blood Type Incompatibility (ABO & Rh)
In ABO or Rh incompatibility, the mother’s immune system attacks the baby’s red blood cells, causing hemolysis. This rapid breakdown releases large amounts of bilirubin, leading to jaundice. Since newborns can’t clear bilirubin quickly, levels build up fast. Severe cases may need phototherapy or exchange transfusion to remove excess bilirubin and prevent complications.
Genetic and Ethnic Predispositions
Certain genetic traits, like G6PD deficiency, raise jaundice risk by accelerating red blood cell breakdown. East Asian and Mediterranean infants are more prone due to inherited factors. Newborn screening often includes tests for these genetic conditions to guide early treatment.
Pathophysiology of Neonatal Jaundice
Neonatal jaundice results from an imbalance between bilirubin production and elimination. This buildup stems from physiological changes in newborns’ red blood cell turnover, liver function, and bilirubin processing pathways.
Bilirubin Metabolism in Newborns
In newborns, red blood cells break down rapidly, releasing the iron-rich part of haemoglobin that converts to bilirubin. The immature liver has a reduced capacity to conjugate and excrete bilirubin, causing it to accumulate in the bloodstream and present as yellowing of the skin and eyes.
Mechanism of Neonatal Jaundice Development
Jaundice develops when unconjugated bilirubin builds up in the blood due to excessive production, delayed liver processing, or reabsorption from the intestines. The liver’s limited enzymatic activity in neonates slows down bilirubin clearance, increasing the risk of visible jaundice.
Signs and Symptoms of Neonatal Jaundice
Recognising the signs of neonatal jaundice early is essential. While mild jaundice is common, severe symptoms may indicate dangerous bilirubin levels requiring immediate medical attention to prevent long-term complications.
Early Signs of Neonatal Jaundice
Early jaundice appears as yellowing on the face, progressing to the chest and limbs. The whites of the eyes may turn yellow. Babies may show reduced activity, mild sleepiness, and poor sucking. Symptoms typically emerge within 2 to 4 days after birth.
Severe Symptoms of Neonatal Jaundice
Severe jaundice involves yellowing below the chest and legs, difficulty waking the baby, poor feeding, or refusal to suck. Warning signs include high-pitched cries, stiff limbs, arching of the back, and seizures—potential indicators of kernicterus, a severe neurological complication.
Causes of Neonatal Jaundice
Neonatal jaundice arises from both natural physiological changes and underlying medical conditions. Understanding these causes helps caregivers distinguish between harmless jaundice and more serious, potentially life-threatening forms needing treatment.
Physiological Causes of Neonatal Jaundice
Physiological jaundice results from an immature liver’s slow bilirubin processing. Foetal red blood cells break down quickly, increasing bilirubin. This type typically peaks around days 3–5 after birth and naturally resolves by 10–14 days in healthy, full-term newborns.
Pathological Causes
Pathological jaundice may be due to ABO/Rh incompatibility, infections like sepsis or TORCH, or genetic issues like G6PD deficiency. Other causes include biliary atresia or hypothyroidism. Jaundice appearing within 24 hours or lasting beyond 2 weeks is considered abnormal.
Types of Neonatal Jaundice
Neonatal jaundice presents in different forms, each with specific causes and timing. Recognising the type—physiological, haemolytic, or breastfeeding-related helps in selecting appropriate monitoring, intervention, and treatment if necessary.
Physiological Neonatal Jaundice
Physiological jaundice is common in healthy newborns and appears a few days after birth. It results from increased red blood cell breakdown and immature liver function, which delays bilirubin processing. It usually resolves on its own within two weeks.
Haemolytic Jaundice
Haemolytic jaundice arises from excessive destruction of red blood cells (haemolysis). It is often caused by blood type incompatibility between mother and baby, such as ABO or Rh incompatibility, leading to a rapid rise in bilirubin that requires treatment.
Breastfeeding-Related Jaundice
This form of jaundice occurs when a newborn doesn’t get enough breast milk, especially in the first few days. Inadequate intake can cause dehydration and slow bilirubin excretion, increasing levels in the blood. Early feeding support helps manage this condition.
Complications of Neonatal Jaundice
Untreated or severe neonatal jaundice can lead to serious complications, including brain damage and long-term developmental issues. Monitoring bilirubin levels and early intervention are critical in preventing these risks.
Neonatal Jaundice Bilirubin Level and Its Effects
When bilirubin levels rise too high, they can lead to jaundice that affects other organs, particularly the brain. Severe jaundice can cause neurological problems, hearing loss, or developmental delays if not treated in time.
Kernicterus and Brain Damage Risk
Kernicterus is a rare but severe complication of untreated jaundice, caused by extremely high bilirubin levels. It can lead to irreversible brain damage, affecting movement, hearing, and cognitive functions. Early treatment, like phototherapy, can prevent this outcome.
Other Potential Long-Term Effects
Untreated or severe jaundice can cause a range of long-term health issues, including hearing loss, cerebral palsy, cognitive disabilities, and vision problems. These developmental challenges can impact motor skills, learning abilities, and even emotional and behavioural health over time.
Diagnosis of Neonatal Jaundice
Diagnosing neonatal jaundice involves a combination of physical assessments, bilirubin level testing, and classification systems. Early diagnosis and intervention are crucial to prevent complications and ensure proper treatment for affected infants.
Physical Examination and Neonatal Jaundice Chart
A physical examination helps detect jaundice by observing the baby’s skin and eyes for yellowing. The Neonatal Jaundice Chart helps assess the extent of jaundice, with colour changes indicating bilirubin levels. This visual guide aids in evaluating the severity.
Neonatal Jaundice Bilirubin Level Assessment
Bilirubin levels are measured using blood tests to assess the extent of jaundice. A transcutaneous bilirubin meter can also provide a quick, non-invasive estimate. Levels above a certain threshold require immediate treatment, such as phototherapy or other interventions.
Neonatal Jaundice ICD-10 Classification
The ICD-10 classification for neonatal jaundice includes codes for different causes and types. These codes help categorise the condition for medical billing and record-keeping, aiding healthcare professionals in identifying and tracking specific types of jaundice for effective management.
Treatment and Management of Neonatal Jaundice
Proper treatment and management of neonatal jaundice ensure safe bilirubin levels, preventing complications. From phototherapy to monitoring and follow-up care, early interventions improve the infant's health and prevent long-term effects.
Phototherapy for Neonatal Jaundice
Phototherapy uses blue light to break down bilirubin in the skin. This process transforms bilirubin into a form that can be more easily eliminated by the baby’s body. It’s one of the most common and effective treatments for jaundice.
Exchange Transfusion for Severe Cases
In severe cases of jaundice, an exchange transfusion may be necessary. This involves replacing the baby’s blood to rapidly lower bilirubin levels. It is typically used when other treatments like phototherapy are insufficient, especially in cases of haemolytic disease.
Home Care and Dietary Adjustments
For mild jaundice, home care may be sufficient. Ensuring adequate feeding (breastfeeding or formula) is key for hydration and bilirubin excretion. Parents should follow paediatric advice on feeding frequency and monitor for signs of worsening jaundice.
Intravenous Immunoglobulin (IVIG) Therapy
IVIG therapy is used for cases of Rh incompatibility, where the mother’s immune system attacks the baby’s red blood cells. This therapy can help reduce bilirubin levels by inhibiting the destruction of red blood cells, improving the baby’s condition.
Medications and Emerging Treatments
New medications and treatments are emerging to manage neonatal jaundice more effectively. These options aim to improve bilirubin clearance and reduce complications.
- Phenobarbital: A medication that can help speed up bilirubin breakdown.
- Apheresis: A new technique used in extreme cases of jaundice.
- Gene therapy: Emerging research for future treatment of jaundice-related genetic disorders.
Hydration and Fluid Therapy
Hydration plays a crucial role in managing jaundice by helping the liver process and excrete bilirubin more efficiently. IV fluids may be administered to ensure the baby remains hydrated, promoting better clearance of bilirubin and reducing the need for more invasive treatments.
Monitoring and Follow-Up Care
Parents should schedule bilirubin level checks regularly during the first few days after birth. If jaundice persists beyond the expected timeline, further monitoring is necessary. Regular paediatric follow-up visits ensure that bilirubin levels are stable and prevent complications.
Nursing Diagnosis and Management of Neonatal Jaundice
A structured nursing care plan is crucial for effective neonatal jaundice management. This includes thorough assessment, proper interventions, and clear parental guidance to ensure the baby’s well-being and safe recovery.
Nursing Diagnosis for Neonatal Jaundice
Nursing diagnoses for neonatal jaundice focus on several concerns that affect the newborn’s health, including:
- Impaired Neonatal Thermoregulation: Difficulty maintaining body temperature due to jaundice.
- Risk for Fluid Volume Deficit: Insufficient hydration may worsen jaundice.
- Risk for Neurological Impairment: Severe jaundice can impact brain function.
Nursing Interventions and Best Practices
Nurses should follow standardised interventions to promote jaundice resolution and prevent complications. This includes administering phototherapy and closely monitoring its effectiveness in breaking down bilirubin.
Providing feeding support is crucial to ensure proper hydration, which aids in bilirubin excretion. Nurses should also assess the baby’s jaundice progression regularly, tracking bilirubin levels and skin colour changes to ensure timely intervention if necessary.
Parental Education and Support
Parental guidance is essential in jaundice management:
- Teaching Parents How to Recognise Severe Jaundice: Educating on signs like extreme sleepiness and poor feeding.
- Helping Parents Understand Treatment Options: Explaining phototherapy and other interventions.
- Emotional Support for Parents: Offering reassurance and addressing concerns.
Prevention of Neonatal Jaundice
Prevention plays a crucial role in managing neonatal jaundice. By addressing risk factors both before and after birth, the likelihood of severe jaundice can be reduced, ensuring better health outcomes for newborns.
Prenatal Prevention Strategies
Prenatal care can significantly reduce the risk of neonatal jaundice. Key prevention strategies include maternal blood type and Rh screening to detect incompatibility risks. Managing maternal health conditions, such as diabetes, and ensuring a balanced pregnancy diet help maintain optimal foetal health, reducing jaundice risk.
Postnatal Monitoring and Care
Post- birth care focuses on early intervention to prevent jaundice from worsening. Initiating feeding soon after birth helps prevent dehydration, which can worsen jaundice. Routine bilirubin screening before hospital discharge ensures early detection.
Additionally, encouraging skin-to-skin contact, especially in the “Golden Hour,” supports healthy bilirubin levels and bonding. Regular follow-up visits with paediatricians ensure ongoing care and monitoring.
Early Detection, Better Outcomes: Trust Cadabam’s Diagnostics for Neonatal Jaundice Screening
Early detection of neonatal jaundice can significantly improve health outcomes for babies. Trust Cadabam’s advanced diagnostics to ensure timely screening and precise management of jaundice.
With a focus on early intervention and comprehensive care, Cadabam’s reliable screening methods help parents and healthcare providers make informed decisions, reducing the risk of complications and ensuring the baby’s healthy development.