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Neonatal Jaundice – Causes, Symptoms & Treatment

Neonatal jaundice is a common yellowing of the skin and eyes in newborns caused by elevated bilirubin levels. It is usually harmless but may require treatment in some cases.

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Things worth knowing about "Neonatal jaundice"

Neonatal jaundice is a common yellowing of the skin and eyes in newborns caused by elevated bilirubin levels. It is usually harmless but may require treatment in some cases.

What is Neonatal Jaundice?

Neonatal jaundice (also called neonatal icterus or neonatal hyperbilirubinemia) is a yellow discoloration of the skin and whites of the eyes in newborn babies. It occurs when there is too much bilirubin -- a yellow pigment produced during the breakdown of red blood cells -- in the blood. Neonatal jaundice is very common, affecting approximately 60% of full-term and up to 80% of preterm newborns.

Causes

Neonatal jaundice can be classified as physiological (normal) or pathological (abnormal):

Physiological Causes

Breakdown of fetal red blood cells: After birth, fetal hemoglobin is replaced by adult hemoglobin, leading to increased red blood cell breakdown and bilirubin production.
Immature liver function: The newborn liver is not yet fully developed and cannot process and excrete bilirubin efficiently.
Increased enterohepatic circulation: Newborns have limited gut bacteria, which leads to greater reabsorption of bilirubin from the intestines.

Pathological Causes

Blood group incompatibility (hemolytic disease of the newborn): Differences in blood type between mother and baby (e.g., Rh or ABO incompatibility) can cause increased red blood cell destruction.
Infections: Neonatal infections can increase bilirubin production.
Metabolic disorders: Rare inherited conditions such as Gilbert syndrome or Crigler-Najjar syndrome can impair bilirubin excretion.
Biliary atresia: A congenital malformation of the bile ducts that prevents the normal flow of bile.
Breast milk jaundice: In some cases, substances in breast milk may slow the processing of bilirubin.

Symptoms

The typical signs of neonatal jaundice include:

Yellowing of the skin: Usually starts on the face and spreads to the trunk, arms, and legs.
Yellow discoloration of the whites of the eyes (sclera).
Poor feeding or excessive sleepiness in cases of very high bilirubin levels.
In severe, untreated cases: muscle stiffness, high-pitched crying, or altered consciousness (signs of bilirubin encephalopathy).

Diagnosis

Neonatal jaundice is typically diagnosed using the following methods:

Clinical assessment: Visual examination of skin color by doctors or midwives.
Transcutaneous bilirubinometry (TcB): A non-invasive device measures bilirubin levels through the skin.
Blood test: Measurement of total bilirubin and direct (conjugated) bilirubin in the blood to identify the underlying cause.
Additional tests such as complete blood count, blood group testing, and the Coombs test if blood group incompatibility is suspected.

Treatment

Treatment depends on the bilirubin level and the gestational age of the baby:

Phototherapy (Light Therapy)

Phototherapy is the most common treatment. The newborn is placed under a special blue-light lamp. The light converts bilirubin in the skin into a water-soluble form that can be excreted through urine and stool. The baby's eyes are protected during treatment.

Exchange Transfusion

In severe cases with very high bilirubin levels or when phototherapy is insufficient, an exchange transfusion may be necessary. The baby's blood is gradually replaced with donor blood to rapidly lower bilirubin levels.

Adequate Nutrition and Hydration

Frequent breastfeeding or supplemental feeding helps promote bilirubin excretion through the gut and should be encouraged.

Treatment of Underlying Cause

In cases of pathological jaundice (e.g., infection or biliary atresia), the underlying condition is treated alongside the jaundice.

Prognosis

Physiological neonatal jaundice is generally self-limiting and resolves within one to two weeks without specific treatment. With timely management, the prognosis is excellent. However, untreated severe hyperbilirubinemia can lead to permanent neurological damage, known as kernicterus or bilirubin encephalopathy. Early detection and monitoring are therefore essential.

References

World Health Organization (WHO): Newborn Health - Neonatal Jaundice. WHO Guidelines, 2023. Available at: https://www.who.int
American Academy of Pediatrics (AAP): Clinical Practice Guideline: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 2022.
Maisels MJ, Bhutani VK, Bogen D et al.: Hyperbilirubinemia in the Newborn Infant ≥35 Weeks Gestation: An Update With Clarifications. Pediatrics, 2009;124(4):1193-1198.

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