More than half of all newborns develop a weaker or more pronounced yellowing of the skin shortly after birth, which is harmless in most cases. However, abnormal neonatal jaundice absolutely must be treated.
What is neonatal jaundice?
About 60 percent of healthy newborns experience a noticeable yellowing of the skin in the first few days of life: neonatal jaundice. It results from accumulations of the yellow bile pigment bilirubin. In many cases, the symptoms are harmless and disappear on their own. This is called physiological neonatal jaundice, which does not require treatment. However, if the symptoms persist over a period of time and the bilirubin levels in the blood exceed a certain mark, the condition must be treated. In the case of premature birth, the risk of neonatal jaundice increases to 80 percent. In technical language, this is also referred to as neonatal jaundice.
Causes
In most cases, neonatal jaundice is due to normal metabolic processes after birth: In the womb, the fetus is supplied with oxygen via many red blood cells. These are of a certain type, abbreviated HbF. After birth, the infant can breathe on its own. He therefore needs fewer red blood cells and also a different type, HbA. The old blood cells must therefore be broken down, forming the yellow bilirubin. The liver of newborns, which is not yet fully developed, is not yet able to convert larger amounts of bilirubin into an excretable form quickly enough, resulting in yellowing of the skin. Increased breakdown of blood cells can occur, for example, if the blood types of mother and child are incompatible. Major bruising after birth and congenital anemia can also increase the incidence of neonatal jaundice. Premature birth, a disposition disorder of the bile ducts, certain metabolic disorders or some medications are other causes that can lead to a deficient breakdown of bilirubin. Children suffering from the so-called Crigler-Naijar syndrome lack the enzyme responsible for the breakdown of bilirubin. Breastfeeding can also trigger mostly physiological neonatal jaundice. The reasons for this are not yet well understood.
Symptoms, complaints, and signs
Neonatal jaundice typically occurs within the first few days of life. It is manifested by initially yellowing of the skin and yellowish-white discoloration of the white skin of the eye. Usually, the sick infants show a slightly sickly appearance and behave unusually. Thus, there may be increased activity or apathy, depending on the level of bilirubin and the individual course of the disease. If bilirubin levels do not exceed a certain level, neonatal jaundice resolves on its own. Further complications or late effects are not to be expected in this case. At higher levels, on the other hand, bile pigments can be deposited in the brain. This can lead to physical and mental complaints – the so-called kernicterus occurs. Sick infants are constantly tired and yawn frequently. Appetite and drinking behavior are reduced, resulting relatively quickly in deficiency symptoms and dehydration. As the disease progresses, muscle tension increases and the typical hollow back with a stretched-out back develops. In addition, the child becomes increasingly restless, cries and cries or is apathetic in the meantime. Respiratory distress and seizures also occur at this stage of the disease. In the long term, severe neonatal jaundice can lead to hearing and vision problems, developmental disorders and malformations.
Diagnosis and course
Physiologic neonatal jaundice develops between the third and sixth days after birth and resolves by the tenth or fourteenth day. The yellowing of the skin and white of the eye is clearly visible. If necessary, the doctor checks the bilirubin levels in the blood. The physician obtains initial information with the aid of a multispectral device. This allows him to measure the amount of colored light that can penetrate the skin. If there are indications of elevated values, blood tests are carried out that provide clues to the causes. Furthermore, the gall bladder and liver are checked, for example with ultrasound images.Pathological 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, there may be increased muscle tension with the back pressed through to a hollow back, shortness of breath, shrill screaming and seizures. Late effects may include visual and hearing impairment, decreased mental development, and movement abnormalities.
Complications
Neonatal jaundice or neonatal icterus occurs in 60 percent of newborns and is usually harmless. The condition is caused by the necessary remodeling or replacement of red blood cells after birth. The massive breakdown of the 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 if left untreated, and the yellow discoloration disappears completely after 10 to 14 days. However, if pathological neonatal jaundice is present, serious symptoms may develop if left untreated, which may also cause irreversible damage. If the concentration of bilirubin in the blood is too high due to the inability to break it down, the substance can settle in the brain. A so-called kernicterus then develops, which leads to increased muscle tone. The affected newborns are usually sleepy and drink poorly. They tend to have a pronounced hollow back, shrill cries, and also seizures and respiratory distress. If left untreated, they may also develop irreversible late effects such as visual and hearing impairments, movement abnormalities and reduced mental development. An effective therapy is irradiation of the skin with blue light. This facilitates the conversion of bilirubin into its water-soluble form, which greatly facilitates its breakdown and excretion.
When should you see a doctor?
In the case of an inpatient birth or a delivery attended by obstetricians, the nurses, midwives or physicians present will perform the initial examinations of the newborn. If they detect irregularities or peculiarities in the infant’s general health, they independently take further steps to ensure adequate medical care. In these cases, the parents or relatives do not have to become active. However, if the first signs of a health impairment do not appear until a few days after birth, the parents must take action. If there is a change in the appearance of the skin, yellowing of the skin or behavioral abnormalities 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 neonatal jaundice does not necessarily require medical attention, a visit to the doctor is generally recommended. In particular, medical examinations should rule out other diseases so as not to endanger the life of the newborn. Muscle tension, apathy or apathy are further indications that should be investigated. If the infant shows an excessive need for sleep or a disturbance in respiratory activity, a physician should be informed of the observations. If respiratory distress develops, a physician should be consulted immediately.
Treatment and therapy
Pathological neonatal jaundice is often treated with light or phototherapy. This involves shining blue light on the skin, which stimulates the bilirubin to change into its water-soluble form. This allows the body to break down the dye more easily. As a side effect of light therapy, a harmless skin rash may form that is usually not itchy. If the bilirubin concentration in the blood is greatly increased, blood exchange by means of an exchange transfusion is necessary. In premature infants and in infants in whom jaundice occurs particularly early, treatment is started quite quickly. If the neonatal jaundice lasts longer, it is probably a disorder of the bile ducts. In this case, light therapy may be a good remedy.
Prevention
There are very few ways to prevent neonatal jaundice. As much as possible, the baby should not be taken out of the womb before the due 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 may also be useful.
Aftercare
Because most cases of jaundice in newborns do not require therapy, there is usually no need for specific follow-up. Healing usually occurs within a short time without treatment. After two to three weeks at the latest, the baby’s yellowish skin color should have disappeared on its own. If this is not yet the case, additional measures may be necessary on the advice of the physician. As a rule, however, no special follow-up examinations are necessary due to jaundice. The attending pediatrician will monitor the condition as part of the usual check-ups for newborns. In addition, the midwife will continue to monitor whether the jaundice has healed completely or whether action is needed. If the symptoms persist over a longer period of time, the pediatrician usually orders a current blood test of the child. The bilirubin level is checked again. Depending on the findings, further follow-up measures or renewed therapy may then be necessary. However, taking the affected child out into the daylight is the most important follow-up measure for neonatal jaundice. This is especially necessary if the newborn has already been treated in the hospital using phototherapy.
What you can do yourself
If it is already foreseeable in the postpartum ward that he is a dangerous form of jaundice of the newborn, treatment measures are already resorted to in the hospital. However, there are some methods that parents can use to help the jaundice subside at home. 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 falling through the window. At the same time, it is essential to keep the room warm. Direct sunlight would be better, but there is a risk that the child will catch an infection. The window glass lets the important “blue” part of the light through anyway. At the same time, it helps to stimulate the newborn’s intestinal activity. Then the bilirubin already secreted by the liver, which leads to jaundice, is excreted directly and there is no danger of it getting back into the body. The child should be taken to the breast as often as possible to stimulate milk production. Whether intestinal activity is actually stimulated can be seen from the child’s frequent bowel movements. However, supplementary feeding with bottle food or even complementary food should be avoided, as this only leads to irritation of the newborn’s body. Giving water or tea can also be dispensed with. Breast milk alone is sufficient.
