Understanding Neonatal Jaundice: Causes, Symptoms, and Treatment

Some newborn babies develop jaundice, as their liver cannot process and eliminate bilirubin, causing bilirubin levels to increase. As a result, their skin and eye whites become yellow. The medical term for this condition is neonatal jaundice.

What is neonatal jaundice?
Neonatal jaundice occurs when blood levels of bilirubin rise significantly in infants. Bilirubin is a yellow pigment the baby’s body produces when old red blood cells are broken down.

While you are pregnant, your liver eliminates bilirubin for the baby. However, your baby's liver must start eliminating bilirubin after birth. A newborn's liver may be unable to remove bilirubin if it is underdeveloped. As a result, your baby's skin and eyes could appear yellow when excess bilirubin accumulates.

Jaundice is usually harmless and often fades away within 2 to 3 weeks as a baby begins to feed and the liver matures. But if jaundice lasts for more than three weeks, it can be a symptom of an underlying condition that, if left untreated, might damage the brain. For this reason, it's crucial to visit the doctor if your baby has jaundice.

Causes of neonatal jaundice
A high bilirubin level in your baby's blood causes jaundice. Newborns produce more bilirubin than adults because red blood cells are produced and depleted more quickly in the first few days of life. Normally, bilirubin is removed by the liver from the blood and sent to the intestines for excretion.

However, hyperbilirubinemia occurs when an undeveloped liver cannot filter out bilirubin as quickly as it is generated. This results in excess bilirubin, which leads to jaundice.

Other causes of newborn jaundice include:

A blood infection (sepsis).
A different blood type than you.
Bruising from a difficult birth (Eg. bleeding underneath the scalp).
High red blood cell count.
A low oxygen level (hypoxia).
A liver condition such as biliary atresia.
An enzyme deficiency.
Blocked bile duct or bowel.
UTI (Urinary tract infection) or pneumonia infection.
Liver, gallbladder, or pancreas malfunction.
Sickle cell anemia.
Underactive thyroid gland (Congenital Hypothyroidism).

Besides this, breastfeeding can also cause infant jaundice. Neonatal jaundice occurs in breastfed babies in two separate forms:

Breastfeeding jaundice occurs during the first week of life, especially if the infant is not eating properly or the mother's milk is slow to come in.
Breast milk jaundice occurs when some substances in breast milk prevent bilirubin from being broken down properly. It starts after seven days of life and peaks between 2 to 3 weeks later.

Neonatal jaundice risk factors
Common risk factors for infant jaundice are:

Premature birth: A newborn before 38 weeks of gestation might not be able to process bilirubin as fast as a full-term baby because the liver is not fully developed. Additionally, premature infants may consume less and have fewer bowel movements, resulting in less bilirubin being removed through stool.
Bruising during birth: Newborns who sustain bruising may have greater bilirubin levels due to the breaking down of red blood cells during delivery.
Rhesus or ABO blood type incompatibility: If the mother has a blood type different from that of her child, the infant could have absorbed antibodies through the placenta that target the fetus's red blood cells, leading to an accelerated breakdown.
Breastfeeding: Babies who are breastfed are more likely to develop jaundice, especially if they have difficulty nursing or aren't getting enough nutrients. The development of jaundice may be facilitated by dehydration or a low-calorie intake. Experts still advise breastfeeding, nevertheless, because of its advantages.
Race: According to studies, infants of East Asian heritage are more likely to develop jaundice.

Symptoms of neonatal jaundice
The primary symptom of jaundice is the yellowing of a baby’s skin and the whites of the eyes. The yellowing may start 2 to 4 days after birth. It usually begins at the head and moves down to the chest, stomach, arms, and legs.

Yellowing could be more noticeable in other places, like:

Inside their mouth.
On the bottom of their feet.
On the palms of their hands.

Other symptoms of infant jaundice can also include:

Yellow abdomen or limbs.
Pale stools: Breastfed babies should have greenish-yellow stools, while bottle-fed babies should be a greenish-mustard color.
Poor sucking or feeding.
Dark urine: A newborn’s urine should be colorless.
Inability to gain weight.
Neurological signs: Changes in muscular tone, seizures, or altered crying must be treated immediately to prevent kernicterus.

To check for jaundice, examine your baby, preferably in natural daylight. First, softly press your infant's forehead or nose. Your baby most likely has mild jaundice if the skin where you pressed appears yellow. If your infant doesn't have jaundice, the skin tone should appear slightly paler than usual.

How is neonatal jaundice diagnosed?
Babies are checked for jaundice before the mother and child are discharged after delivery. Your child’s pediatrician may also want to see your baby again 3 to 5 days after birth when bilirubin levels are usually at the highest. The blood's bilirubin concentration will be measured to determine the degree of jaundice.

Bilirubin levels can be checked via:

Visual examination: The doctor will examine your baby's gums, the colour of their urine, and the whites of their eyes.
Serum bilirubin (SBR) blood test: Your baby's heel will be pricked to get a little blood sample. The blood will then be tested for total serum bilirubin (TSB) levels.
Transcutaneous bilirubinometer (TcB) device: Light will be shined onto your baby's skin, measuring how the light bounces off or is absorbed by the skin to determine the amount of bilirubin present.

The type of treatment will depend on the level of bilirubin (jaundice severity).

More examinations may be required to rule out any underlying conditions if a newborn has jaundice. Your infant may be examined for the following:

Moreover, a Coombs test may be done to check for increased red blood cell breakdown.

Neonatal jaundice treatment
Jaundice in babies typically doesn't require treatment. As your baby's liver develops, mild cases of jaundice often go away on their own, although this can take a week or more.

Frequently feeding your infant (10 to 12 times daily) can promote defecation (bowel movements). This aids your infant in eliminating extra bilirubin from their body.

If your baby’s bilirubin level is high or continues to rise, your doctor may recommend the following:

Phototherapy
Ultraviolet light is used in phototherapy to treat skin conditions. During phototherapy, your baby will be put on a special bed and exposed to a blue spectrum light, wearing only diapers and special safety goggles.

The light modifies the bilirubin molecules' shape and structure so they can be excreted in urine and stools. Thus, helping your baby’s liver get rid of excess bilirubin quicker. During phototherapy, your baby will be assessed for indications of dehydration, and their temperature will be monitored to ensure they don't get too hot. If your infant is dehydrated and is unable to consume enough, intravenous fluids may be required.

After phototherapy has begun, the bilirubin levels will be checked every 4 to 6 hours to see how well the treatment works. Once the bilirubin levels have stabilized or begun to decline, your baby will be monitored every 6 to 12 hours again.

Phototherapy will be discontinued when the bilirubin levels are safe. In some circumstances, it could just take one day or less, or up to 5 to 7 days. If your baby’s bilirubin levels aren’t too high, you might be able to treat your infant at home with light treatment.

Exchange transfusion
An exchange transfusion may be required in severe cases when phototherapy is unsuccessful. During the transfusion, a tiny plastic tube will be inserted into blood vessels in your baby's arms, legs, or umbilical cord to extract blood.

Then, small amounts of blood from a matching donor substitute the baby's damaged blood with healthy red blood cells. This procedure lowers bilirubin levels and raises the baby's red blood cell count.

Your infant will be carefully monitored throughout the transfusion procedure, which might take many hours to complete. Within 2 hours after the treatment, blood will be drawn from your baby to determine whether it was effective. The procedure might have to be repeated if your baby's blood bilirubin level remains high.

Complications of neonatal jaundice
Severe jaundice can result in serious complications if untreated.

Acute bilirubin encephalopathy
Acute bilirubin encephalopathy is a condition caused by bilirubin buildup in the brain. Bilirubin is toxic to brain cells, and prompt treatment is needed to prevent long-term damage.

Signs of acute bilirubin encephalopathy include:

Sluggishness
Difficulty waking
High-pitched crying
Poor sucking or feeding
Backward arching of the neck or body
Fever

Kernicterus
Kernicterus is can be potentially fatal. It occurs if acute bilirubin encephalopathy causes permanent brain damage. Kernicterus might lead to:

Involuntary and uncontrolled movements (Athetoid cerebral palsy)
Issues in maintaining regular eye movements (Baby looks from side to side or upwards rather than straight ahead)
Learning disabilities
Loss of hearing
Improper tooth enamel growth

Neonatal jaundice treatment cost
The treatment cost may vary depending on the services provided in different hospitals and the duration of the stay. Nonetheless, neonatal jaundice treatment may cost a few thousand ringgit in private hospitals in Malaysia.

As such, it’s important to be prepared with the finance for neonatal jaundice treatment if you’re expecting a baby - and one of the best ways to do so is with maternity insurance.

Insurance for neonatal jaundice
Prudential offers PRUMy Child Plus, a protection insurance plan that offers coverage for all mothers and their babies from 13 weeks of pregnancy. This plan provides childcare benefits for babies with neonatal jaundice, where they will receive Phototherapy Treatment within 60 days of birth. Besides this, PRUMy Child Plus also covers 27 congenital conditions, all structural congenital conditions and admission into ICU or HDU.

Can neonatal jaundice be prevented?
Infants' jaundice is common and unavoidable in many cases. However, frequent feedings can lessen the chance of severe jaundice. Regular bowel movements are stimulated by frequent feedings, which will assist your infant in eliminating bilirubin.

Breastfeed: During the first week of life, nurse your baby 8 to 12 times a day to ensure that they receive adequate nutrients. To assist bilirubin flow through your baby's body more rapidly, ensure that they are not dehydrated.
Formula-feed: During the first week of life, you should give your infant 1 to 2 ounces (30 to 60 millilitres) of formula every 2 to 3 hours. If you are worried that your baby is consuming too little or too much formula or if they don't wake up at least eight times every 24 hours to feed, consult your doctor.

Before leaving the hospital, ensure your baby's bilirubin level is checked by a healthcare professional. Then, plan a follow-up appointment for the bilirubin level to be rechecked during your newborn's first week.

Is neonatal jaundice common?
Yes, neonatal jaundice is the most common condition that affects newborns. According to estimates, 6 out of every 10 infants develop jaundice, including 8 out of 10 infants delivered before the 37th week of pregnancy. However, only 1 in 20 infants have blood bilirubin levels requiring treatment.

When and where to seek treatment for neonatal jaundice in Malaysia?
You should seek treatment if your baby’s jaundice increases, lasts longer than two weeks or if you notice any of the symptoms mentioned above.

Because jaundice in babies is a common condition, most hospitals with pediatric units will be able to provide the treatment. Thus, paying a visit to your child’s pediatrician is the best first step if you suspect your baby has jaundice.

Conclusion
If you suspect your baby has neonatal jaundice or has been showing symptoms, you should seek medical attention and get treatment immediately. Remember to always carefully monitor your baby for yellowing of the skin and eyes. For more information about insurance on pregnancy and neonatal conditions such as jaundice, visit Prudential’s website or speak to our wealth planners today.