Jaundice commonly occurs in newborns, with up to 80% of neonates experiencing symptoms. In most cases, jaundice is not serious in newborns and either resolves itself or requires non-invasive treatment by phototherapy.
Only 10% to 15% of babies have bilirubin levels that require treatment, and only 2% of babies or less are at risk for developing severe hyperbilirubinemia. Severe cases do occur, however, and the consequences can be life-threatening.
Jaundice is frequently found in babies affected by hemolytic disease of the fetus and newborn (HDFN), with bilirubin levels tested at birth via cord blood tests. Early diagnosis and treatment ensure the best outcomes.
What is bilirubin?
Bilirubin is a molecular byproduct of the breakdown of hemoglobin, the protein responsible for holding the oxygen transported in red blood cells. It is normally transported to the liver, where it undergoes a transformation called conjugation, and is then excreted from the body through the intestines. Jaundice is caused by the accumulation of bilirubin in the blood, which is known as hyperbilirubinemia.
What is jaundice?
Jaundice is the yellowing of the skin and the whites of the eyes because of a buildup of bilirubin in the blood. Bilirubin is a yellow pigment that is a byproduct of the breaking down of red blood cells. In babies affected by HDFN, the red blood cells are destroyed by maternal antibodies, leading to higher levels of bilirubin than normal.
Learn more about HDFN symptoms and risks
How is jaundice treated?
High bilirubin levels in the blood that either increase or remain unchanged, require treatment to break up the bilirubin, converting it into a water-soluble form that can easily be eliminated by the body.
The first-line treatment for jaundice is phototherapy, a blue light. The baby’s skin is exposed to the blue light, with their eyes protected, in an incubator or wrapped in a bili blanket. The baby’s bilirubin levels will be checked every four to six hours and when the levels start to fall, they will be tested every six to 12 hours.
Phototherapy is usually effective, but if bilirubin levels don’t fall, more intensive treatment is required. Intravenous immunoglobulin (IVIG) is the next option and is used after phototherapy to help slow the breakdown of the red blood cells.
An exchange transfusion is a complete blood transfusion in which the baby’s blood is removed and replaced with the blood of a blood donor. This effectively removes the bilirubin from the blood.
When is jaundice considered serious?
When jaundice is severe, diagnosis was delayed or treatment is slow to achieve results, the bilirubin can cross the blood-brain barrier and damage the brain and central nervous system. This is a dangerous complication called kernicterus, that can lead to death or long-term neurological damage. The impact can include deafness, vision issues, cerebral palsy, seizures, delayed cognitive development and speech disorders.
Early diagnosis and treatment of jaundice in an HDFN-affected newborn is most often effectively treated with phototherapy, avoiding serious complications such as kernicterus.
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