Cause, Management and Treatment of Neonatal Jaundice

A neonatal jaundice may be defined as yellowish coloration of skin mucus membrane, cornea and other tissues due to increased concentration of bilirubin in body fluid / blood of a newborn infant. In neonates, more than 5mg/dl bilirubin level in blood is known as jaundice.

Count of bilirubin according to body color:

Head up to neck- 6mg/dl

Neck, chest up to umbilicus – 10 to 12mg/dl

Umbilicus up to thigh – 12 to 15mg/dl

Hands, legs and trunk – 15 to 18mg/dl

Whole body including palm and sole – 16 to 12mg/dl

Types of Neonatal Jaundice:

1. Physiological
2. Pathological

Physiological Jaundice:

When jaundice appears on second or third day of birth of a newborn baby and disappears within 7 to 10 days is known as physiological jaundice. In case of premature babies, it may take a little later.

In a term infant the level of unconjugated bilirubin is generally 6 to 8mg/dl. It may rise up to 12mg/dl. In a preterm infant the level of unconjugated bilirubin may rise up to 12 to 15mg/dl in the first week.

Pathological Jaundice:

When jaundice appears within 24 hours of birth of a baby, bilirubin level increasing at a rate of 5mg/dl per day and persists more than 2 weeks is known as pathological jaundice.

In a term baby, in pathological jaundice unconjugated bilirubin level is higher than 12mg/dl. Jaundice persisting more than 1 week. In a preterm baby unconjugated bilirubin level is higher than 15mg/dl. Jaundice persisting more than 2 weeks.

Causes of Jaundice:

1. Physiological cause.
2. Pathological: Pathological Jaundice are 15 types.

1. Excessive destruction of RBCs due to Haemolytic disease of newborn.
2. Rh incompatibility, ABO incompatibility.
3. Congenital Spherocytosis
4. Neonatal Septecaemia
5. Cytomegalic Disease
6. Biliary tract obstruction, viral hepatitis
7. Breast milk jaundice (galactosaemia)
8. Hypoglycaemia
9. Intrauterine infection (Toxoplasmosis), Syphilis.
10. G-6 PD disease (Glucose – 6 Phosphate Dehydrogenase Deficiency)
11. Intracranial haemorrhage.
12. Cephalhaematoma
13. Asphyxia
14. Acidosis
15. Drug therapy

Investigations to be done:

1. Hb%
2. Full blood count, TC, DC, WBC, platelet count.
3. Bilirubin level –total, direct, indirect.
4. Blood grouping & Rh typing
5. Peripheral blood film
6. Liver function test
7. Coombs test-direct, indirect

Treatment of Neonatal jaundice:

1. Estimation of serum bilirubin both conjugated and unconjugated.
2. Phototherapy-If serum bilirubin is higher than 12mg/dl in term baby & higher than 10mg/dl in preterm baby.
3. Drugs: Metaloporphyrins, phenobarbitone, Vitamin K 1mg I/M stat and daily for three days,Tab vitamin E 1/8^th tab daily.
4. Exchange transfusion: If unconjugated bilirubin level is higher than 18mg/dl in blood in term baby and higher than 15mg/dl in preterm baby.
5. Treatment of causes of jaundice like Infection, hypoglycaemia, acidosis, anaemia.

Precautions during phototherapy:

1. Frequently change the posture of the baby, approximately 2 hourly.
2. Observe the infant for signs of dehydration.
3. Maintain skin temperature.
4. Cover infant`s eye to protect retina from damage due to light.
5. Cover Genitalia in male child to protect testis from damage.
6. Remove infant from light for 15 minutes for feeding, remove eye pads at this time.
7. Dress the baby while remove from lights.
8. Carefully examine eyes for irritation from eye patches.