Newborn Jaundice

This yellowish discoloration of the skin and lining membranes of the eyes and gums is a common observation in about a third of all healthy newborns. The yellowish color is due to the deposition of yellow pigment called bilirubin in the tissues. Bilirubin is formed when red blood cells break down. Large amount of bilirubin exerts toxic effect on the brain causing a condition called kernicterus. Kernicterus when severe, results in death, otherwise, it may cause permanent brain damage and impaired hearing. Premature babies are more susceptible to the damage from bilirubin than the term baby.
 

Physiological jaundice

This is a normal phenomenon in the first week of life for most babies. As the rate at which bilirubin is formed (from the breakdown of the red blood cell) is greater than the rate at which it is metabolized and discarded by the body. Physiological jaundice is not apparent until the third day, reaching a peak by about the 4th or 5th day of life. It becomes barely recognizable by about the 10th day of life. Maximum values are usually below 300 mmol/L or 17.6 mg/dL and do not cause any harm to the baby’s health. If the levels rise to beyond 17.6 mg/dL (or 300 mmol/L) within a few days of life, the baby will need to be investigated further.

The bilirubin levels can be estimated with some degree of accuracy by observing the intensity of jaundice. However, this may not be consistent and is subjective, thus, testing of the blood for to confirm the levels is often necessary. As a rough rule, if newborn jaundice is easily recognizable only over the face, the level is likely to be below 220 mmol/L (11 mg/dL). If the newborn jaundice is easily recognizable in the extremities, the possibility of the bilirubin levels being over 300 mmol/L (17.6 mg/dL) is high.

Your role as a parent is to learn to detect newborn jaundice and present your baby to a health worker for a decision on the need for a blood test or phototherapy treatment.
 

G6PD deficiency

This is an inherited condition (usually from the mother) affecting mainly the males. These babies have decreased levels of the enzyme Glucose 6 Phosphate Dehydrogenase (G6PD) in their red blood cells. As a result, the red blood cells are easily broken down when exposed to triggers like naphthalene in moth balls, fava beans, some of the sulfur containing drugs, drugs used in treating malaria and infections. This deficiency is rare in the Caucasian but common in the Chinese.
 

Phototherapy

This is the treatment for newborn jaundice. The naked baby is exposed (eyes covered with eye pad) to light emitted from fluorescent bulbs for about 48 hours. The blue spectrum light acts to convert the bilirubin to a non-toxic and water soluble substance. After the commencement of phototherapy, the bilirubin levels can be kept effectively at safe levels.
 

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