Jaundice occurs in more than half of newborn infants in the first week. Jaundice, which is usually a transient condition, can sometimes be a serious first sign of another disease. Jaundice occurs as a result of the destruction of red spheres. When the old red spheres collapse, the hemoglobin in it turns to bilirubin and is removed from the body by the liver. Elevated bilirubin in the blood is called hyperbilirubinemia. Bilirubin is a yellow pigment that dyes the baby's skin and tissues yellow. In time, jaundice disappears with the maturation of the liver.
Jaundice can occur for various reasons. Physiological jaundice is the normal response of the baby to remove bilirubin from the body within the first week. Breast milk jaundice occurs in 2% of infants after the first week. Jaundice may also occur as a result of hemolysis or destruction of red spheres due to Rh or ABO incompatibility. In addition, due to infection or other causes of inadequate liver function is another cause of jaundice.
It does not cause any problems when the jaundice bilirubin is at low levels. High levels may affect the central nervous system and cause brain damage. This is called kernicterus.
It usually starts with the yellowing of the baby's face and then spreads to the lower parts of the body and proceeds. Apart from this, it may cause decrease in absorption and tendency to sleep. Families can assess whether the baby has jaundice by taking care of the baby's skin and the white part of the eye. It is more convenient to look at the baby's skin under daylight. Apart from this, the easiest method is to press the baby's nose or forehead with your finger so that the baby's skin looks white. If it looks yellow, it should be evaluated by the pediatrician for jaundice. Bilirubin levels can be measured with a small amount of blood taken from the baby. Further testing may be required at high bilirubin levels.
The time of jaundice is also helpful in the evaluation. Jaundice that develops in the first 24 hours is serious and requires immediate treatment. The jaundice that occurs on the second and third days is usually physiological jaundice. However, there is a possibility of serious jaundice. Jaundice that occurs between the third day and the first week may be due to infection. Jaundice in the second week may be due to breast milk or other causes.
Parents should consult a physician if:
* Jaundice detected in the first 24 hours.
* Jaundice lasting more than 14 days.
* In cases where the baby does not suck the breast well.
* The stool is too light or white.
* Urine is dark in color.
* The baby is prone to sleep or is extremely restless.
Treatment depends on the cause of jaundice and the level of bilirubin. The aim is to keep the bilirubin level below the dangerous limit. No treatment is necessary for mild jaundice. High bilirubin levels decrease when the baby is exposed to special wavelength lights. In this treatment called phototherapy, the eyes of the baby are closed and intermittent hospitalization is changed so that the body receives sufficient light. Bilirubin level should be monitored during treatment. Rarely, blood exchange is applied in severe jaundice. High bilirubin levels are lowered using fresh blood. If jaundice occurs due to any underlying disease, treatment of this disease will lower the bilirubin level.
Jaundice seen in the neonatal period cannot be completely prevented, but early diagnosis and treatment will prevent the bilirubin from reaching dangerous limits.
Dr. Namdar Uluşahin
Bayındır Hospital Neonatal Doctor