Symptoms
Often – depending on the severity of the jaundice – there is only a visible yellowing of the skin and the sclerae of the newborn without any further symptoms. The yellowing itself is not noticeable to the offspring. This is usually the case with physiological, harmless neonatal jaundice.
If, however, for various reasons, massive amounts of bilirubin are produced which cannot be broken down and excreted, this can in turn penetrate some nerve cells in the brain and lead to cell death (nuclear icterus). Then a wide variety of symptoms, especially neurological symptoms, can occur. These include a conspicuous weakness in drinking and tiredness or apathy of the newborn, weakened newborn reflexes, shrill screaming, cramping of the neck and back muscles (opisthotonus) as well as a downward glance of the eyes when the eyelids open (sunset phenomenon).
Laboratory values
In over 50% of all newborns, neonatal jaundice occurs in the first weeks of life. Often the yellowing of the skin is due to completely natural processes at this age. The level of bilirubin is a marker for the degree of neonatal jaundice.
Bilirubin is a yellow breakdown product of the red blood pigment haemoglobin. An increase in bilirubin above typical age values must be further clarified and treated. Highly elevated bilirubin levels can cause severe damage to the newborn.
Bilirubin determination can be performed non-invasively through the skin. A light signal is used to determine the degree of yellowing of the skin and compare it with standard values corresponding to the baby’s age. For a more precise assessment in the case of elevated values, the total bilirubin in the blood is usually determined.
In the first week of life, the level of total bilirubin must not exceed 15mg/dl in the sense of normal (physiological) neonatal jaundice.Everything above it is pathological, i.e. has disease value. On the first day of life, the value of total bilirubin must not exceed 7mg/dl. If this is the case, one speaks of premature neonatal jaundice (Icterus praecox).
In contrast, neonatal jaundice as Icterus prolongatus can persist for more than a week. In order to find the cause, a further breakdown in the blood into direct and indirect bilirubin must be made in addition to the total bilirubin. Depending on the level of the values, appropriate therapy is initiated.
For babies born at the appointment, phototherapy is initiated if the value exceeds 20 mg/dl. In premature babies, the indication for phototherapy is usually given earlier, as even lower values lead to damage. In the case of children born at maturity with a value of more than approx.
25mg/dl, a blood exchange transfusion must be initiated. The physiological, harmless neonatal jaundice usually begins directly in the first days of life (approx. day 3-6), often peaks around the 5th day of life and then gradually recedes without consequences until approx.
day 10. However, if the children are already born with a newborn jaundice, or if this already occurs within the first 24-36 hours, one speaks of an early jaundice (Icterus praecox), which is usually caused by a blood group incompatibility between mother and child (Morbus haemolyticus neonatorum). If the mother has a different blood group characteristic (rhesus factor) than the child, the mother may produce antibodies against the child’s “foreign” blood cells and these antibodies may enter the child’s blood system.
This can lead to the destruction of the child’s red blood cells and an increased attack of the red blood pigment. If the newborn jaundice usually lasts longer than two weeks, it is called prolonged jaundice (Icterus prolongus). Under certain circumstances, this can be an indication of a disorder of the bilirubin metabolism, which may be congenital or acquired and requires further clarification.
