Jaundice in Newborn: Causes, Symptoms and Diagnosis

Updated: June 16, 2022

Jaundice in newborn babies,also known as neonatal jaundice is very common and usually harmless condition that causes yellowing of the skin and the whites of the eyes.
Usually the symptoms of newborn jaundice develop 2 to 3 days after the birth and tend to get better without treatment by the time the baby is about 2 weeks old.
If the symptoms quickly get worse or the baby become very reluctant to feed, your baby needs treatment.

Causes of Jaundice in Newborn:

Jaundice in newborn babies is caused by an excess of bilirubin. Bilirubin is a waste product, produced when red blood cells are broken down. It is normally broken down in the liver and removed from the body in the stool.
The baby  has a different form of hemoglobin before it is born. Once they are born, the old hemoglobin starts to break down very rapidly. This will result in production of higher than normal levels of bilirubin that must be filtered out of the bloodstream by the liver and sent to the intestine for excretion. Since the liver of the baby is underdeveloped, it cannot filter out the bilirubin as fast as it is being produced, resulting in an excess of bilirubin called as hyperbilirubinemia.
Jaundice in newborns is commonly caused by breast-feeding which have two separate forms:

Breast-feeding jaundice :

This may occurs in the first week of life, if the baby does not feed well, or if the mother's milk is slow to come in.

Breast milk jaundice :

This occurs when the substances in the breast milk interfere with the breakdown process of bilirubin. It occurs after 7 days of life, peaking at 2-3 weeks.
Some of the severe form of jaundice in new born babies are linked to an underlying disorder . This is the case if jaundice develops shortly after birth (within the first 24 hours). Some of the underlying disorder are:

• liver disease
• hepatitis which is an inflammation of the liver
• sepsis which is a blood infection
• cephalohematoma which is bleeding underneath the scalp, caused by a difficult delivery
• sickle cell anemia
• blocked bile duct or bowel
• an abnormality of the baby's red blood cells
• ABO incompatibility which occurs when the mother and baby have different blood types, the mother's antibodies attack the baby's red blood cells.
• higher numbers of red blood cells which is more common in smaller babies and twins.
• bacterial or viral infections
• hypothyroidism which refers to an underactive thyroid gland
• enzyme deficiency
• some infections including syphilis and rubella
• hypoxia which indicates low oxygen levels

Symptoms of Jaundice in Newborns:

The most common sign of jaundice in newborn babies is yellow skin and sclerae (the whites of the eyes). This usually starts at the head, and spreads to the chest, stomach, arms, and legs.
Symptoms of infant jaundice can also include:

• drowsiness
• poor sucking or feeding
• dark urine(a newborn's urine should be colorless)
• pale stools (breast-fed babies should have greenish-yellow stools, while those of bottle fed babies should be a greenish-mustard color or orange)
• high-pitched cry
• irritability

Diagnosis of Jaundice in Newborns:

Before being discharged from the hospital, the newborn babies are recommended to undergo test for jaundice. The test should be repeated after 3-5 days of birth. In breast-fed babies who are well and feeding and gaining weight appropriately, this can be normal and the symptoms goes away by time.
Diagnosis of jaundice in newborn babies can be done based on appearance alone. However, the severity of jaundice will be determined by measuring levels of bilirubin in the blood. Bilirubin levels can be checked through a serum bilirubin (SBR) blood test or a transcutaneous bilirubinometer device, which measures how much of a certain light shines through the skin. If the jaundice persists for more than 2 weeks, further blood tests and urine tests can be performed to check for underlying disorders. This may include testing your baby for their complete blood count (CBC), testing for their blood type, testing for Rhesus factor (Rh) incompatibility, and a Coombs test, which may be positive in cases of increased red blood cell breakdown.