Up to every second full-term newborn develops jaundice during the first days of life. In prematurely born infants it is even more common.
Jaundice is caused by excessive accumulation of bilirubin in the tissues.
Hospital stay in maternity hospitals is often short and hence the infant may develop jaundice only after discharge from the hospital.
Unconjugated bilirubin concentrations exceeding the safety limits may cause neurological injury.
The diagnoses are made in the paediatric unit of the maternity hospital.
Aetiology and symptoms
Prematurity is the most important predisposing factor to developing jaundice.
Blood group immunizations (ABO or Rh immunization) are the most common pathological causes of developing severe newborn jaundice.
Other pathological causes include, among others, infections, large bruises and caput succedaneum. In such cases the infant often becomes jaundiced already before the age of 2 days (48 hours).
Nowadays, as hospital stay in maternity hospitals has become increasingly shorter, the infant may develop jaundice only after getting home.
A jaundiced infant appears languid and gets tired easily. Getting only a meager amount of milk and significant loss of weight increase the risk of developing jaundice.
In addition to observing the skin, jaundice should be assessed also by examining the sclerae (whites of the eyes).
Diagnosis and treatment
If the infant develops jaundice only after getting home, the family should contact directly the maternity hospital during the 2 first weeks of life.
If a child develops jaundice after the 2 first weeks of life, he/she should be referred to a paediatric outpatient clinic urgently (appointment within a week) or as an emergency case immediately on the next working day. Performing laboratory tests is not necessary prior to the referral.
When the bilirubin concentration exceeds the phototherapy threshold, the jaundice is treated by phototherapyPhototherapy for Neonatal Jaundice and adequate hydration. The phototherapy threshold is dependent on the child's gestational age, birth weight and chronological age.
Phototherapy may be carried out in the maternity hospital or also at home, monitored by a hospital at home service.
The duration of treatment is defined by the bilirubin levels.
If jaundice persists beyond the age of 2 weeks, it is regarded as prolonged jaundice and its cause must be investigated, then the latest. Breast milk jaundice is the most common type of jaundice in the over 2 week old infants. In these cases, the child appears healthy and gains weight. Discontinuing breastfeeding is not recommended.
If jaundice that developed in a newborn infant persists beyond the age of 2 weeks, the conjugated bilirubin should always be determined. If the conjucated bilirubin, measured by a separate laboratory test, is > 20% of the total bilirubin or over 20 µmol/l, additional investigations are urgently needed in the specialized care (often in a tertiary care hospital) to exclude biliary atresia.
Determining the conjugated bilirubin may be performed in primary health care, provided that the result is rapidly available and will not cause a delay in referring the infant to specialized care.