Jaundice in Childhood
Introduction
Newborn jaundice is a common condition that occurs when bilirubin — a yellow pigment produced from the breakdown of old red blood cells — accumulates in the bloodstream. Normally, the liver processes bilirubin and removes it through stool. During pregnancy, the mother’s liver performs this function for the baby. After birth, however, the newborn’s liver must take over, and because it is still developing, bilirubin levels may temporarily rise, causing yellowing of the skin and eyes.
Causes of Jaundice
1. Physiological Jaundice (Normal Jaundice)
This is the most common type. While in the womb, the placenta removes bilirubin for the baby. After birth, the newborn’s liver, still immature, needs several days to function effectively. As a result, bilirubin may accumulate between day 2 and day 4 of life and usually resolves within two weeks without treatment.
2. Pathological Jaundice
This type is more serious and requires immediate medical evaluation. Causes include:
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Jaundice within the first 24 hours of birth (a medical emergency).
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Hypothyroidism, where the thyroid gland does not produce enough hormones.
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Blood type incompatibility between mother and infant (e.g., Rh or ABO incompatibility).
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Urinary tract infection (UTI) in newborns.
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Crigler–Najjar syndrome, a rare genetic disorder affecting bilirubin metabolism.
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Biliary obstruction or congenital problems in the bile ducts or gallbladder.
Symptoms
Newborn jaundice typically appears as yellow discoloration of the skin. It starts on the face and progresses downward to the chest, abdomen, arms, and legs as bilirubin levels rise. Yellowing of the whites of the eyes is also common. Detecting jaundice may be more difficult in infants with darker skin tones.
When to See a Doctor
Seek urgent medical care if any of the following occur:
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Difficulty waking the baby or unusual sleepiness.
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Jaundice appearing within the first 24 hours after birth.
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Fever in a newborn.
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Poor feeding or refusal to breastfeed.
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Less than 4–6 wet diapers per day or fewer than 3–4 bowel movements by day four.
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High-pitched or unusual crying.
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Arching of the back, stiff muscles, or body twisting forward.
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Rigidity or abnormal posture.
Risk Factors
Newborns have a higher risk of developing jaundice if they have:
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Darker skin tones (may make detection harder; requires closer monitoring).
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A family history of blood disorders.
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A sibling who previously had neonatal jaundice.
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Poor feeding in the first days of life.
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Premature birth (before 37 weeks).
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Bruising or birth trauma.
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Blood type incompatibility with the mother.
Complications
If bilirubin levels become dangerously high, bilirubin may enter the brain and cause serious complications such as:
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Acute bilirubin encephalopathy (temporary but serious condition).
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Kernicterus, a form of permanent brain damage.
Long-term complications may include: -
Cerebral palsy.
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Hearing loss.
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Vision and dental problems.
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Intellectual disabilities.
Early monitoring and timely treatment are essential to prevent severe hyperbilirubinemia.
Treatment
The goal of treatment is to lower bilirubin levels safely and efficiently. Many newborns improve naturally within two weeks. However, treatment is required if levels are high:
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Phototherapy: Special blue-light therapy that converts bilirubin into a form the body can eliminate.
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Exchange transfusion: Used in severe cases; the infant’s blood is replaced with donor blood to rapidly reduce bilirubin.
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Sunlight exposure is not recommended as a safe or effective treatment for jaundice.
Prevention
Parents and caregivers can reduce the risk of severe jaundice by:
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Ensuring frequent breastfeeding (8–12 times per day in the first days).
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Completing newborn screening tests and bilirubin checks after birth.
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Monitoring the infant closely during the first five days after birth.
Keywords
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