The first 28-day period of life, which begins for the baby at birth, is called the neonatal period. During this period, infants may experience some negativities regarding adaptation to the outside world.
How Does Neonatal Jaundice Occur?
Neonatal jaundice is also a common health problem seen in approximately 60% of all babies. In preterm babies, this probability is much higher and reaches 80% levels. The problem of jaundice in newborns is not usually due to any disease and is therefore called physiological jaundice. It usually gets better on its own within a few weeks.
The cause of jaundice in newborns is the accumulation of excess bilirubin in the baby's blood. This causes yellowing of the baby's skin and whites of the eyes. Jaundice usually progresses from the head to the feet, and yellowing of the legs indicates a severely increased bilirubin level. Although it is a common condition that is seen in many babies and usually heals spontaneously, it definitely requires a doctor's control. Bilirubin is a substance released by the breakdown of red blood cells.
In order for bilirubin to be cleared from the blood, the baby's liver must have reached a certain maturity. Bilirubin, which accumulates in the blood and cannot be removed sufficiently until the baby's liver reaches this capacity, causes yellowing of the skin and whites of the eyes. Detection and follow-up of jaundice is very important for newborn babies. Although jaundice usually resolves within a few days or a week as the liver matures, in some cases, too much bilirubin can cause a condition called kernicterus (bilirubin encephalopathy), which can lead to brain damage.
Our country ranks 3rd in the world in terms of the incidence of kernicterus. In rare cases, ignoring jaundice in some babies and not applying to health institutions for follow-up can lead to serious problems that can progress to disability in the baby. Therefore, babies with jaundice should be followed up by a physician for a week or ten days. cli.
What are the Symptoms of Neonatal Jaundice?
The most common and obvious symptom of infant jaundice is yellowing of the skin and whites of the eyes. This condition commonly occurs 2-4 days after birth and jaundice may increase over time. To check your newborn's jaundice, you can gently press his forehead or nose to see if yellow color is seen where you press.
Recognition of yellow color indicates mild jaundice in the baby. In babies without jaundice, a slightly lighter color than normal skin should be seen at the imprinted area. It is useful to do this check in a well-lit environment, preferably in daylight. The places where jaundice is seen in the baby also give an idea about the level of bilirubin in the blood. Bilirubin level in the blood:
- If it is between 5 and 8 mg/dl in the head and neck region,
- If it is between 8 and 10 mg/ in the upper part of the body,
- If it is between 10 and 13 mg/dl in the lower part of the body,
- If it is between 13 and 16 mg/dl in the arms and legs,
- 20 mg/dl If it is around dl, yellowing occurs on the hands and feet.
- If the jaundice started within the first 24 hours,
- If the jaundice spreads and gets worse by getting a darker color,
- If the baby has a high fever,
- If the baby's nutrition is not good,
- If the baby is tired and sleeps more than usual, the doctor should be consulted immediately.
What are the Causes of Neonatal Jaundice?
While the mother's liver ensures that bilirubin, which is released by the breakdown of red blood cells while the baby is still in the mother's womb, is cleared from the blood, an adaptation process may be required as this task passes to the baby's liver after birth. It usually takes several days for the baby's liver to become competent enough to clear bilirubin. Therefore, the probability of developing jaundice in preterm babies is higher due to the immaturity of the liver.
In addition to this, jaundice due to breastfeeding is a natural condition that occurs especially if the mother is not educated about breastfeeding and milk It occurs when the baby does not get enough breast milk due to the slow delivery of the baby. Just like physiological jaundice, breastfeeding jaundice also improves within 1 week if breastfeeding is given importance. Apart from this, abnormal conditions that may cause jaundice in the baby include:
- Infection in the baby's blood (sepsis),
- Blood incompatibility between the mother and the baby,
- The presence of liver disease in the baby,
- Congestion of the baby's bile ducts and other problems,
- Enzyme deficiencies,
- Sickle Abnormal blood cell diseases such as cell anemia,
- Genetic diseases,
- Some factors such as difficult birth, multiple pregnancy and high maternal age.
What are the Types of Neonatal Jaundice?
The jaundice seen in newborns usually develops as one of the following 5 different types:
- Physiological (Normal) Jaundice: It is the most common type of jaundice that develops in most newborn babies due to the immaturity of the liver. It starts 2-3 days after birth and resolves spontaneously within 1-2 weeks at the latest.
- Premature Jaundice: Mild physiological jaundice in term babies can heal spontaneously without any treatment, while jaundice with the same bilirubin values can be treated in premature babies.
- Breastfeeding Jaundice: It is the type of jaundice that develops due to the baby not getting enough breast milk. This type of jaundice heals spontaneously with the education to be given to the mother about breastfeeding properly and with frequent breastfeeding. The increase in blood levels is caused by some substances in breast milk. Bilirubin cannot be excreted through the intestines. This type of jaundice starts 3-5 days after birth and usually heals within 3-12 weeks. If the baby develops jaundice when the baby has a blood type, AB0 incompatibility may be in question. The mother's body is the part of the red blood cells in the baby. It produces antibodies that cause it to bleed, and as a result, the level of bilirubin in the baby's blood rises. This type of jaundice usually appears on the first day of delivery. It can be easily treated with the help of Anti-D Gamma Globulin injections or blood incompatibility needles as it is known among the people. In some cases, phototherapy applications may be required for the baby.
How is Neonatal Jaundice Diagnosed?
Investigation of neonatal jaundice is included in the postnatal follow-up procedures of most health institutions. It is a condition that is followed up after birth. If jaundice is seen in the baby, the mother and baby are discharged with appropriate treatments and recommendations. However, in some cases, jaundice may occur after the mother and baby are discharged.
Therefore, mothers who have just given birth should be careful and observe their babies for a while. In the jaundice examination, it is investigated whether there is yellowing on the baby's skin and whites of the eyes. If signs of jaundice are observed, serum direct and indirect bilirubin levels are examined through a blood test. Jaundice can be diagnosed if high bilirubin levels are found. After some diagnostic tests such as blood type of mother and baby, blood hemoglobin level, determination of reticulocyte in blood, peripheral smear and direct Coombs test are applied, the type of jaundice is fully diagnosed and treatment applications are initiated.
How is the Treatment of Neonatal Jaundice? ?
The aim in the treatment of neonatal jaundice is to prevent permanent problems that may occur due to the accumulation of high levels of bilirubin in the brain and central nervous system, such as kernicterus. In some cases, especially if the baby was born on time, if the jaundice is mild and it is thought to be able to heal spontaneously, the baby can be kept under follow-up without any treatment. Apart from this, the following 3 methods are generally preferred for jaundice that requires treatment:
1) Phototherapy (Light Therapy)
Considering how many days the baby is and how much weight he weighs, if the bilirubin level is above 15 mg/dL, the most The most common treatment method is phototherapy. With this treatment, the bilirubin accumulated in the skin is reduced by the light used in phototherapy. With the effect it causes, it becomes water soluble and is excreted from the body with urine through the kidneys. During the treatment, the baby is stripped so that only the diaper remains, and a light-protective mask is put on his eyes. Since there will be fluid loss during the treatment in the baby who is placed under the light source, breastfeeding is provided at least every 2 hours or the baby is fed with the help of formula formulas in order to prevent dehydration.
2) Blood Exchange (Exchange Transfusion)
If the blood bilirubin levels are excessively high, exchange transfusion is required in the baby. This treatment is generally preferred in infants with a blood bilirubin level of 2-25 mg/dL and above.
3) Pharmacological Agents
In some cases, some drug applications may be preferred to reduce high bilirubin levels. Pharmacological agents used in the treatment act by helping to accelerate the excretion of bilirubin in the body and reduce bilirubin production.
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