Neonatal jaundice: what it is, what are the causes and recommended treatment
Neonatal jaundice occurs in a newborn baby with the characteristic yellow discoloration of the skin, sclera (the whites of the eyes) and mucous membranes. In most cases there is no need to worry: jaundice in the first days of life can be completely physiological, destined to disappear in a short time and - indeed - can represent a positive factor for the newborn for its anti-oxidant action. as we'll see.
Neonatal jaundice is caused by high blood levels of bilirubin, a substance derived from the metabolism of hemoglobin which is present in red blood cells. When bilirubin exceeds a certain level (ie 3 milligrams per deciliter), the classic yellow color appears on the face, on the sclerae and, subsequently, on the entire trunk and limbs. Let's discover together the characteristics of neonatal jaundice, when it is pathological or derived from breast milk.
Neonatal jaundice: when jaundice in newborn babies is physiological
Jaundice, as we have said, can be simply physiological and destined to disappear on its own in the first days of the baby. This type of jaundice tends to occur 24 hours after birth, generally between the second and third day of life, and presents levels of constant bilirubin, whose values do not increase as happens in pathological cases, and do not exceed the established limits.
It is also always indirect total bilirubin, that is bilirubin itself insoluble in the blood, which must bind to another substance called albumin in order to be transported to the liver and become soluble there, making it possible to excrete it through the bile.
Physiological jaundice lasts no more than 10 days in full-term infants, 15 in babies born before term, and affects approximately 60% of the former and 80% of the latter.
Causes of the high bilirubin levels that cause jaundice in infants
What causes jaundice in infants? The answer is in the baby's liver.Jaundice occurs if there is an increase in the bilirubin load on the liver and / or a delay in the liver in eliminating bilirubin. This delay is usually caused by the infant not having fully developed yet. the metabolism for the disposal of this substance It is not by chance that, as we have seen, it is more frequent in percentage terms in preterm infants.
Also not to be overlooked are the possible elements of predisposition: if the mother, for example, suffered from diabetes during pregnancy, or if the birth was induced.
Neonatal jaundice from breast milk
A particular type of neonatal jaundice is the one related to breast milk, which takes the name of "breast milk jaundice". It occurs when bilirubin levels rise after 4-5 days of life, during which time it is breastfed by the mother.
The newborn, in these cases, is to be considered healthy, although this jaundice can last up to 12 weeks. To cause it would be a substance present in breast milk that would increase the reabsorption of bilirubin from the intestine: this is, however, a hypothesis not yet fully understood.
If, on the other hand, the breast-fed infant presents in the first days of life, in addition to jaundice, even weight losses, it could simply be a lack of nutrition: when he is able to take in enough breast milk, then the " jaundice.
In general, the "jaundice from breast milk is considered physiological, and there is therefore no need for any treatment, just a little patience, then the skin will return to its normal color. Of course, bilirubin levels they will be kept under medical supervision, but breastfeeding must not be stopped. Here's a video on how to choose between breast milk and formula:
When jaundice in infants becomes pathological
In less frequent cases, "neonatal jaundice can be pathological. This can happen for different causes. The most common occurs when the indirect bilirubin increases due to the so-called" Rh factor incompatibility "(ie if the blood mother is Rh negative and the baby's blood Rh positive) or "blood group AB0 incompatibility" (mom with blood group zero and child of group A or B). When these cases occur, the mother produces antibodies which bind to the baby's red blood cells and cause them to be destroyed, causing bilirubin levels to rise.
Today, fortunately, these cases occur less frequently because the mother is made to take specific antibodies following the first pregnancy precisely to avoid these incompatibilities in the following ones.
Among the other causes that can cause neonatal jaundice we find congenital anomalies of the red blood cell, infections, rare genetic diseases, polycythemia, lack of specific enzymes, congenital hypothyroidism and others, which will be ascertained with the necessary tests.
Treatment of pathological neonatal jaundice
Once the causes of the pathological neonatal jaundice have been ascertained, a specific treatment must be carried out, to avoid problems in the growth of the child, even after some time. The doctor can choose to proceed with phototherapy, which consists in subjecting the newborn to a beam of light that helps to degrade bilirubin, facilitating its elimination.
If phototherapy does not give the desired results, the so-called "exsanguinotransfusion" can be used: with a blood transfusion from Rh-negative group 0 donors, the child will be able to remove excess bilirubin and most of the red blood cells invested by antibodies maternal.
For further scientific information on neonatal jaundice, you can consult the website of the Bambino Gesù Pediatric Hospital.
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