Neonatal jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes. is commonly observed in newborns, with approximately 60% of full-term newborns and 80% of preterm newborns experiencing jaundice in the first week of life.
It can vary in severity and usually responds well to treatment, namely phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus.. However, in some rare cases, “Bronze Baby” syndrome can occur as a complication of exposure to the light during phototherapy.
What is jaundice?
Jaundice is the yellowing of the baby’s skin and the whites of the eyes. Onset is usually quite rapid post-delivery, often 24-36 hours following birth. It occurs when bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage. levels in the newborn’s blood become elevated. In most cases, jaundice is mild, and no treatment is required, and it resolves with the help of adequate feeding. However, some newborns – in particular preterm babies – have difficulty breaking the bilirubin down and eliminating it from their blood, as their livers are too immature. For example, babies born with hemolytic disease of the fetus and newborn (HDFN) typically exhibit jaundice.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells.) factor (Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen. or Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen.) during pregnancy. Numerous antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. to RBC antigensAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. can be linked to HDFN, such as those from the ABO and Rh blood groupBlood group A classification of blood based on inherited markers found on red blood cells. The ABO and Rh blood groups are most common in HDFN. systems.
If left untreated, jaundice can have severe consequences, including kernicterusKernicterus A rare but serious brain condition caused by very high bilirubin levels. which can cause permanent brain damage, deafness and seizures. Treatment starts with phototherapy and then if bilirubin levels do not drop, an exchange transfusion may need to be considered.
Learn more about HDFN treatment and care
Phototherapy
Phototherapy is the main treatment of neonatal jaundice and in most cases, symptoms disappear in a matter of days. The baby is placed under a special blue light, with their eyes covered to avoid retinal damage. It safely breaks down the bilirubin in the newborn’s blood and so it can be eliminated via the baby’s stool and urine.
Minor side effects of phototherapy include diarrhea, water loss from the skin and in rare cases, “Bronze Baby” syndrome has been observed.
“Bronze Baby” syndrome
A rare and unpredictable complication of phototherapy, “Bronze Baby” syndrome is characterized by a gray-brown discoloration of the skin following exposure to phototherapy. The discontinuation of phototherapy is usually recommended and if the jaundice doesn’t resolve, another treatment may be required, such as an exchange transfusion. Skin discoloration usually disappears in the following days and weeks.
While “Bronze Baby” syndrome is usually mild, with no lasting side effects, it may indicate an underlying liver disorder, such as cholestasis that requires further investigation. In most cases, once the light therapy is stopped, the bronze or brown-gray skin color starts to fade.
