Jaundice

Jaundice is defined as the yellowish tint of the skin, mucous membranes and secretions due to an increase in bilirubin in the blood (a product resulting from the breakdown of red blood cells in the liver). This increase in bilirubin occurs because the newborn's liver cannot eliminate it through the intestine and it accumulates in the bloodstream. In pregnancy, the placenta removes bilirubin from the baby and the mother's liver is in charge of processing bilirubin and eliminating it through the feces.

Neonatal jaundice is usually a mild disorder that resolves without treatment. This is what is called "physiological jaundice," which appears between the second and third day and resolves in two weeks. In this case the baby is healthy and without disease.

About 60% of healthy newborns have jaundice; This begins in the head and face and then extends to the trunk and extremities (from head to toe). You can easily see if the color of the skin turns white when you press with your finger. When jaundice decreases, it does so in the opposite direction to its appearance: from head to toe.

In other cases, jaundice can be a sign of disease in the newborn.

Causes

The appearance of jaundice in the healthy newborn is due to:

• The hemoglobin concentration drops sharply during the first days of life, eliminating a large amount of bilirubin that the liver cannot eliminate.
• Red blood cells (red blood cells) have a shorter life span than adults, and their breakdown causes large amounts of bilirubin.
• Liver function is very ineffective in the first days of life.

Jaundice is an aspect to control for two reasons:

• It can be a sign of a serious illness: infection or blood group incompatibility.
• An excess of unconjugated bilirubin in the blood can deposit in the brain and cause serious neurological damage: cerebral palsy and deafness.

The age of onset of jaundice in the newborn is a key guide to knowing the probable cause of jaundice:

Jaundice that starts in the first 24 hours of life:

• Congenital infections: cytomegalovirus, herpes, rubella, syphilis, toxoplasmosis ...
• Hemolytic processes: these are diseases that cause the massive destruction of red blood cells. In these cases, bilirubin levels can be very high and cause brain damage, which is why early diagnosis is very important.
• Incompatibility of blood groups (see section).
• Glucose-6-phosphate-dehydrogenase deficiency (G6PD): disease that consists of the deficiency of an enzyme present in red blood cells (G6PD) and that makes them sensitive to being destroyed by some drugs and the ingestion of beans.
• Spherocytosis: red blood cells in the shape of a sphere that makes them very fragile, so they break easily.

Jaundice that starts between two days and two weeks of life:

• Physiological jaundice: it is a normal process that affects more than half of newborns; It is not related to any health problem and resolves without treatment within two weeks of life. It is due to the immaturity of liver function. It is the most common cause of jaundice in the newborn.
• Breastfeeding jaundice: This is another common form of newborn jaundice that does not represent severity. The cause of this hyperbilirubinemia is unclear. The yellowish tint on the baby's skin can remain for up to two months but has no repercussions for their health. The mother can safely continue to breastfeed her child.
• Infection: sepsis, urine infection, pneumonia ...
• Cephalohematoma.
• Polycythemia: presence of high levels of red blood cells. It is more frequent in premature babies.
• Prematurity.

Jaundice that begins with more than two weeks of age:

• Breastfeeding jaundice: It does not cause problems for the baby.
• Infection.
• Congenital hypothyroidism.
• Bile duct atresia: is an obstruction of the ducts that carry bile from the liver to the gallbladder.
• Neonatal hepatitis.

Treatment

In cases of physiological jaundice and breastfeeding, no type of treatment is necessary, since it is a normal state of the baby and they resolve spontaneously.

The most common treatment for jaundice caused by disease is exposure of the newborn to ultraviolet light (phototherapy). The child is placed under an ultraviolet lamp for a few hours a day. UV light breaks down bilirubin and helps the baby's liver get rid of it.

When bilirubin rises to levels considered dangerous or phototherapy is not effective, an exchange transfusion is performed. It consists of drawing blood through the baby's umbilical vein and it is replaced by donor blood