Infant jaundice: Bilirubin, kernicterus and more

infant jaundice, smiling baby wrapped in white blanket

Having a baby is an exciting, joyful event in a family’s life. For parents, it can also be an anxious, worrisome time, especially if mom or baby show signs of distress during pregnancy, labor, delivery or postpartum care. It’s important for a pregnant woman to reduce stress in her life as much as possible. It’s also important, however, for her to be aware of possible issues that may arise that may place her health or her baby’s health at risk. Parents have a right to expect that their postpartum medical teams will closely monitor their infant to watch for signs of trouble. For instance, mom, dad or a medical team member notices signs of infant jaundice, it is cause for concern.

An APGAR score might suggest infant jaundice

infant jaundice, adult hand lifting infant's feet

Moments after a baby is born, the attending medical team gives him or her an APGAR score. APGAR stands for appearance, pulse, grimace, activity, respiration. A primary issue regarding ‘appearance’ is skin tone. An APGAR rating is recorded on a scale of one to 10. A healthy newborn typically receives scores of 7 or higher. A lower score often suggests distress or an underlying condition that is preventing an infant from thriving. When infant jaundice is present, a newborn’s skin tone often has a yellowish tinge.

Such discoloration may also be present in the whites of a baby’s eyes or, in advanced stages, on other parts of the body, as well. If an APGAR score shows a rating below 7 for appearance, jaundice should be ruled out. There are several types of tests that help doctors determine whether an infant has neonatal jaundice. A mom or dad can do a quick check, especially if they’ve already taken the baby home from the hospital when symptoms arise. By gently pressing on a baby’s nose tip or forehead, a concerned parent can observe a change in skin tone. In a healthy baby, this change will simply appear as a lighter tone than his or her normal color. In a jaundiced infant, however, a yellow tinge might be noticeable when mom or dad presses on the child’s flesh.

Infant jaundice suggests excess bilirubin in a baby’s bloodstream

medical person holding crying newborn, umbilical cord, splattered blood

The human body is an amazing web of systems that perform numerous functions on a daily basis. The liver is a main organ of the excretory system. This system functions 24/7 to help rid the body of metabolic waste. Bilirubin is a byproduct that results from the breaking down of old or damaged red blood cells in the liver. It’s part of the bile in the liver (acidic fluid), which aids in food digestion. Most bilirubin winds up being excreted from the body in urine and bowel movements. Infant jaundice occurs when there’s too much bilirubin in a baby’s bloodstream.

Minor cases of jaundice are not uncommon, especially in infants born sooner than 38 weeks gestation. However, jaundice is a condition that should never be disregarded because, if left untreated, it can cause kernicterus, a potentially life-threatening type of brain damage. Kernicterus is actually a term that refers to a spectrum of brain damage conditions. If not treated in a timely manner, an infant can become comatose or die.

Symptoms of neonatal jaundice and kernicterus

baby in white, sleeping

In addition to a yellowish skin tone, there are numerous other symptoms that would prompt the average postpartum medical team to run further tests to rule out neonatal jaundice and kernicterus. If a baby’s muscles seem limp, or he or she is listless, it may be an adverse health issue. Parents of newborns should expect their infants to cry, sometimes for extended periods of time. However, high-pitched, inconsolable crying may be a symptom of jaundice or kernicterus. Other symptoms include failure to thrive, especially regarding feedings, seizures, discoloration of abdomen or other body parts, erratic eye movements and difficulty rousing an infant from sleep.

Whether you’re a first-time parent or have several children, it’s always best to closely monitor your child, especially in the weeks that follow his or her birth. It’s best to report symptoms that arise to your child’s medical team. If your baby has a particularly cranky night, does it mean that he or she has jaundice or kernicterus? Not necessarily, but it also doesn’t necessarily mean there are no underlying health concerns. It’s always better to seek medical examination and rule out potentially life-threatening conditions than to ignore symptoms, which might make matters worse.

What is the treatment for jaundice or kernicterus?

infant jaundice, baby with cap on head in incubator

Treatments are chosen for various reasons, including severity of an infant’s condition. In mild cases, jaundice might resolve on its own, perhaps by exposing a baby to sunlight (keeping his or her eyes protected) for short periods of time on a daily basis. An immunoglobulin transfusion can be given intravenously, if needed. In severe cases of jaundice, a blood transfusion might be necessary. (Incompatibility between a mother’s blood and her infant’s blood sometimes causes jaundice.)

Kernicterus occurs if bilirubin passes through the barrier to the brain. While it is easily processed and eliminated from the liver, it is toxic to the brain. Intense fluorescent light therapy may help lower bilirubin levels. Enhanced feeding (which prompts more bowel movements and urine excretion) is also a common treatment. Parents should be aware that kernicterus is a medical emergency! Providing treatment in a timely manner can save a child’s life.

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